=====================================================
General NPI Number Information
=====================================================
NPI Number | 1083901441
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ALEXA JADE BROWN PA-C
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/06/2011
-----------------------------------------------------
Last Update Date | 01/06/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 605 CRESCENT PL
-----------------------------------------------------
City | GAHANNA
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43230-3086
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 614-545-7900
-----------------------------------------------------
Fax | 614-545-7901
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 340 POLARIS PKWY
-----------------------------------------------------
City | WESTERVILLE
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43082-7971
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 614-545-7900
-----------------------------------------------------
Fax | 614-545-7901
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363A00000X
-----------------------------------------------------
Taxonomy Name | Physician Assistant
-----------------------------------------------------
License Number | 50.004958RX
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------