MEDICARE: ALEXANDRA L BOURCY-CRANDELL PA-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	363A00000X	Physician Assistant
2	363A00000X	Physician Assistant	PA56628	CA
3	207Q00000X	Family Medicine Physician	PA56628	CA
4	363AM0700X	Medical Physician Assistant	PA56628	CA
5	363AM0700X	Medical Physician Assistant	PA00673	MS

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	PA00673	OTHER	MS	MS MEDICAL BOARD
2	PA56628	OTHER	CA	STATE OF CALIFORNIA DCA

General Provider Information

NPI Number	:	1902373095
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALEXANDRA L BOURCY-CRANDELL PA-C

Provider Business Mailing Address
First Line	:	29 FRIAR TUCK CIR
Second Line	:
City	:	COLUMBUS
State	:	MS
Zip	:	39705-3012
Country	:	US
Telephone Number	:	585-698-0967
Fax Number	:

Provider Business Practice Location Address
First Line	:	1503 HIGHWAY 45 N
Second Line	:
City	:	COLUMBUS
State	:	MS
Zip	:	39705-2113
Country	:	US
Telephone Number	:	662-328-9623
Fax Number	:

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

Provider Enumeration Date	:	10/27/2018
Last Update Date	:	09/26/2022

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Directions to “ ALEXANDRA L BOURCY-CRANDELL PA-C” Practice Location

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