Healthcare Provider Details

I. General information

NPI: 1851772958
Provider Name (Legal Business Name): ALEXANDRA LEE BEWLEY PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2015
Last Update Date: 09/06/2023
Certification Date: 09/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9433 N BEACH ST STE 111
FORT WORTH TX
76244-6306
US

IV. Provider business mailing address

9433 N BEACH ST STE 111
FORT WORTH TX
76244-6306
US

V. Phone/Fax

Practice location:
  • Phone: 817-428-7000
  • Fax:
Mailing address:
  • Phone: 817-428-7000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA10048
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: