Healthcare Provider Details

I. General information

NPI: 1972419885
Provider Name (Legal Business Name): ALEXANDRA SMITH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/20/2026
Last Update Date: 08/20/2026
Certification Date: 08/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

222 GATEWAU BLVD LOT 117
ROCK SPRINGS WY
82901
US

IV. Provider business mailing address

222 GATEWAU BLVD LOT 117
ROCK SPRINGS WY
82901
US

V. Phone/Fax

Practice location:
  • Phone: 307-389-0080
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: