MEDICARE: ALEXANDRIA HEARN PRINCE FNP-C

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	363LF0000X	Family Nurse Practitioner	34676	TN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1407637135
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALEXANDRIA HEARN PRINCE FNP-C

Provider Business Mailing Address
First Line	:	PO BOX 400
Second Line	:
City	:	JACKSON
State	:	TN
Zip	:	38302-0400
Country	:	US
Telephone Number	:	731-422-0213
Fax Number	:	731-423-2073

Provider Business Practice Location Address
First Line	:	2863 HIGHWAY 45 BYP
Second Line	:
City	:	JACKSON
State	:	TN
Zip	:	38305-3618
Country	:	US
Telephone Number	:	731-422-0213
Fax Number	:	731-506-1839

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

Provider Enumeration Date	:	10/09/2023
Last Update Date	:	04/15/2026

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