Provider Demographics
NPI:1184007734
Name:WARNER, ALEXANDRA (APRN)
Entity Type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:
Last Name:WARNER
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2850 TWIN RIVERS DR
Mailing Address - Street 2:
Mailing Address - City:ARKADELPHIA
Mailing Address - State:AR
Mailing Address - Zip Code:71923-4212
Mailing Address - Country:US
Mailing Address - Phone:870-246-8036
Mailing Address - Fax:870-246-7164
Practice Address - Street 1:2850 TWIN RIVERS DR
Practice Address - Street 2:
Practice Address - City:ARKADELPHIA
Practice Address - State:AR
Practice Address - Zip Code:71923-4212
Practice Address - Country:US
Practice Address - Phone:870-246-8036
Practice Address - Fax:870-246-7164
Is Sole Proprietor?:No
Enumeration Date:2015-07-01
Last Update Date:2015-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA004333363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics