Provider Demographics
NPI:1235146937
Name:ALEXANDER-AGRESTA, KARA (PA-C)
Entity Type:Individual
Prefix:
First Name:KARA
Middle Name:
Last Name:ALEXANDER-AGRESTA
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:KARA
Other - Middle Name:
Other - Last Name:ALEXANDER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:PO BOX 27128
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84127-0128
Mailing Address - Country:US
Mailing Address - Phone:801-698-0991
Mailing Address - Fax:
Practice Address - Street 1:3838 S 700 E UTAH CANCER SPECIALIST-CANCER CTR
Practice Address - Street 2:SUITE 100
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84106
Practice Address - Country:US
Practice Address - Phone:801-269-0231
Practice Address - Fax:801-269-0304
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-02
Last Update Date:2015-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT60245451206363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT000060156Medicare PIN