Healthcare Provider Details

I. General information

NPI: 1174828446
Provider Name (Legal Business Name): ALEXANDRIA MARIE SARA NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ALEXANDRIA MCCLURE

II. Dates (important events)

Enumeration Date: 01/18/2011
Last Update Date: 02/20/2025
Certification Date: 02/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1005 DIVISION ST
PRESCOTT AZ
86301-1601
US

IV. Provider business mailing address

PO BOX 81064
CLEVELAND OH
44181-0064
US

V. Phone/Fax

Practice location:
  • Phone: 928-776-8428
  • Fax:
Mailing address:
  • Phone: 520-795-8080
  • Fax: 520-323-6237

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberSP028517
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number15585
License Number StateTN
# 3
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number15585
License Number StateTN
# 4
Primary TaxonomyN
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number4704348250
License Number StateMI
# 5
Primary TaxonomyN
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number15585
License Number StateTN
# 6
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number313964
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: