Provider Demographics
NPI:1255870218
Name:ORNELL, ALEXANDRA JANE (MS, PA-C)
Entity Type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:JANE
Last Name:ORNELL
Suffix:
Gender:F
Credentials:MS, PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4471 LONG PRAIRIE RD STE 100
Mailing Address - Street 2:
Mailing Address - City:FLOWER MOUND
Mailing Address - State:TX
Mailing Address - Zip Code:75028-1755
Mailing Address - Country:US
Mailing Address - Phone:972-316-4555
Mailing Address - Fax:214-285-0791
Practice Address - Street 1:4471 LONG PRAIRIE RD STE 100
Practice Address - Street 2:
Practice Address - City:FLOWER MOUND
Practice Address - State:TX
Practice Address - Zip Code:75028-1755
Practice Address - Country:US
Practice Address - Phone:972-316-4555
Practice Address - Fax:214-285-0791
Is Sole Proprietor?:No
Enumeration Date:2017-02-22
Last Update Date:2020-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA11161363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant