Provider Demographics
NPI:1174184121
Name:PAUL, ALEXANDRA RAE (PA-C)
Entity Type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:RAE
Last Name:PAUL
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:890 ROCKWALL PKWY STE 110
Mailing Address - Street 2:
Mailing Address - City:ROCKWALL
Mailing Address - State:TX
Mailing Address - Zip Code:75032-6871
Mailing Address - Country:US
Mailing Address - Phone:972-494-6764
Mailing Address - Fax:
Practice Address - Street 1:890 ROCKWALL PKWY STE 110
Practice Address - Street 2:
Practice Address - City:ROCKWALL
Practice Address - State:TX
Practice Address - Zip Code:75032-6871
Practice Address - Country:US
Practice Address - Phone:972-494-6764
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-20
Last Update Date:2023-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL085007486363A00000X
TXPA17013363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant