Healthcare Provider Details

I. General information

NPI: 1710683784
Provider Name (Legal Business Name): ALEXANDRA MARIE BERRY PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/01/2023
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

148 SKYVIEW DR
MT STERLING KY
40353-1496
US

IV. Provider business mailing address

148 SKYVIEW DR
MT STERLING KY
40353-1496
US

V. Phone/Fax

Practice location:
  • Phone: 859-499-0717
  • Fax: 859-499-0926
Mailing address:
  • Phone: 859-499-0717
  • Fax: 859-499-0926

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA3258
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: