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General NPI Number Information
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NPI Number | 1013422765
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Entity Type | Individual
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Provider Name | HEATHER ALEXANDER PA-C
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Gender | Female
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Dates
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Enumeration Date | 12/04/2017
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Last Update Date | 12/04/2017
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Provider Practice Location Address
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Address Line | 1514 JEFFERSON HWY
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City | JEFFERSON
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State | LA
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Zip | 70121-2429
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Country | US
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Telephone | 504-842-0434
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Fax |
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Provider Business Mailing Address
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Address Line | 6113 ALEXANDER LN
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City | LONG BEACH
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State | MS
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Zip | 39560-9732
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Country | US
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Telephone | 228-234-6995
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 307505
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License Number State | LA
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