Healthcare Provider Details

I. General information

NPI: 1982103198
Provider Name (Legal Business Name): ALEXANDRA TIRRELL HOBBS NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/03/2018
Last Update Date: 06/10/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2510 LAKELAND DR
FLOWOOD MS
39232-9513
US

IV. Provider business mailing address

2510 LAKELAND DR
FLOWOOD MS
39232-9513
US

V. Phone/Fax

Practice location:
  • Phone: 601-355-1234
  • Fax: 601-352-4882
Mailing address:
  • Phone: 601-355-1234
  • Fax: 601-352-4882

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number20163711
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number902560
License Number StateMS
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number210241
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: