Provider Demographics
NPI:1346519840
Name:ALEXANDER MEDICAL ASSOCIATES
Entity Type:Organization
Organization Name:ALEXANDER MEDICAL ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:MS
Authorized Official - First Name:TRACY
Authorized Official - Middle Name:L
Authorized Official - Last Name:JENKINS
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:865-483-4015
Mailing Address - Street 1:40 NEW YORK AVE
Mailing Address - Street 2:
Mailing Address - City:OAK RIDGE
Mailing Address - State:TN
Mailing Address - Zip Code:37830-6409
Mailing Address - Country:US
Mailing Address - Phone:865-483-4015
Mailing Address - Fax:865-483-4016
Practice Address - Street 1:40 NEW YORK AVE
Practice Address - Street 2:
Practice Address - City:OAK RIDGE
Practice Address - State:TN
Practice Address - Zip Code:37830-6409
Practice Address - Country:US
Practice Address - Phone:865-483-4015
Practice Address - Fax:865-483-4016
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-29
Last Update Date:2012-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN14992363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty