Healthcare Provider Details

I. General information

NPI: 1881050516
Provider Name (Legal Business Name): MS. ALEXANDRA POPKEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/11/2016
Last Update Date: 07/19/2022
Certification Date: 07/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6480 HARRISON AVE
CINCINNATI OH
45247-7961
US

IV. Provider business mailing address

500 E BUSINESS WAY
CINCINNATI OH
45241-2374
US

V. Phone/Fax

Practice location:
  • Phone: 512-354-3700
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number50.007324RX
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberAT005308
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: