Healthcare Provider Details

I. General information

NPI: 1245213586
Provider Name (Legal Business Name): SHERRY A ALEXANDER PAC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/21/2005
Last Update Date: 08/07/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

216 E COLLEGE
MASON TX
76856-1390
US

IV. Provider business mailing address

PO BOX 989
EDEN TX
76837-0989
US

V. Phone/Fax

Practice location:
  • Phone: 325-347-5926
  • Fax: 325-347-5331
Mailing address:
  • Phone: 325-869-5500
  • Fax: 325-869-5692

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA01694
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: