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General NPI Number Information
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NPI Number | 1841052073
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Entity Type | Individual
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Provider Name | ALEXANDRA PULASKI HERNDON
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Gender | Female
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Dates
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Enumeration Date | 01/24/2024
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Last Update Date | 04/28/2025
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Provider Practice Location Address
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Address Line | 101 ROBESON ST STE 200
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City | FAYETTEVILLE
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State | NC
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Zip | 28301-5520
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Country | US
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Telephone | 910-615-1860
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Fax | 910-615-9630
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Provider Business Mailing Address
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Address Line | 131 BRISBON HALL DR
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City | RICHMOND HILL
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State | GA
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Zip | 31324-8833
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Country | US
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Telephone | 912-656-3628
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | F01240808
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License Number State | GA
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