MEDICARE: ALEXA ROSE BUMGARNER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	0010-15374	NC

General Provider Information

NPI Number	:	1205654829
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALEXA ROSE BUMGARNER

Provider Business Mailing Address
First Line	:	1916 W PARK DR
Second Line	:
City	:	NORTH WILKESBORO
State	:	NC
Zip	:	28659-3563
Country	:	US
Telephone Number	:	336-839-9563
Fax Number	:

Provider Business Practice Location Address
First Line	:	1916 W PARK DR
Second Line	:
City	:	NORTH WILKESBORO
State	:	NC
Zip	:	28659-3563
Country	:	US
Telephone Number	:	336-839-9563
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/02/2024
Last Update Date	:	03/02/2026

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Directions to “ ALEXA ROSE BUMGARNER ” Practice Location

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