Healthcare Provider Details

I. General information

NPI: 1023804283
Provider Name (Legal Business Name): ALEXANDRA MARRY KHOURY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/15/2025
Last Update Date: 07/06/2026
Certification Date: 07/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10099 RIDGEGATE PKWY STE 310
LONE TREE CO
80124-5534
US

IV. Provider business mailing address

10099 RIDGEGATE PKWY
LONE TREE CO
80124-5531
US

V. Phone/Fax

Practice location:
  • Phone: 303-790-1800
  • Fax:
Mailing address:
  • Phone: 303-724-7963
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA.0009313
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: