Healthcare Provider Details

I. General information

NPI: 1952684268
Provider Name (Legal Business Name): ALICIA M. ALEXANDER CPNP, PMHS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/22/2011
Last Update Date: 09/20/2024
Certification Date: 09/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

474 INDUSTRIAL LANE PEDIATRIC CLINIC-ONEIDA
ONEIDA TN
37841-4685
US

IV. Provider business mailing address

9000 EXECUTIVE PARK DR C200
KNOXVILLE TN
37923-4685
US

V. Phone/Fax

Practice location:
  • Phone: 423-286-8600
  • Fax: 423-286-8644
Mailing address:
  • Phone: 865-670-6199
  • Fax: 865-670-6188

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2080P0006X
TaxonomyDevelopmental - Behavioral Pediatrics Physician
License Number20227510
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code2080P0008X
TaxonomyPediatric Neurodevelopmental Disabilities Physician
License Number20227510
License Number StateTN
# 3
Primary TaxonomyY
Taxonomy Code364SP0200X
TaxonomyPediatric Clinical Nurse Specialist
License Number16121
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: