Provider Demographics
NPI:1316542665
Name:KOON, ALEXA (PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:ALEXA
Middle Name:
Last Name:KOON
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:ALEXA
Other - Middle Name:
Other - Last Name:SANZONE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:865 LEE ROAD 314
Mailing Address - Street 2:
Mailing Address - City:SMITHS STATION
Mailing Address - State:AL
Mailing Address - Zip Code:36877-3113
Mailing Address - Country:US
Mailing Address - Phone:315-225-1760
Mailing Address - Fax:
Practice Address - Street 1:3700 S RAILROAD ST
Practice Address - Street 2:
Practice Address - City:PHENIX CITY
Practice Address - State:AL
Practice Address - Zip Code:36867-2993
Practice Address - Country:US
Practice Address - Phone:334-664-0463
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-03
Last Update Date:2022-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN11143439163W00000X
AL1-189751363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse