Provider Demographics
NPI:1225890015
Name:MUMFORD, ALEXYS BERNA
Entity Type:Individual
Prefix:
First Name:ALEXYS
Middle Name:BERNA
Last Name:MUMFORD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10013 SUNNY SIDE LN
Mailing Address - Street 2:
Mailing Address - City:TEMPLE
Mailing Address - State:TX
Mailing Address - Zip Code:76502-5370
Mailing Address - Country:US
Mailing Address - Phone:337-378-4279
Mailing Address - Fax:
Practice Address - Street 1:200 BOBCAT WAY
Practice Address - Street 2:
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78665-8033
Practice Address - Country:US
Practice Address - Phone:512-716-2600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-26
Last Update Date:2024-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program