Provider Demographics
NPI:1346583911
Name:BECKETT, ALEXANDRA ROSE (MD)
Entity Type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:ROSE
Last Name:BECKETT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ALEXANDRA
Other - Middle Name:ROSE
Other - Last Name:NICHOLS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:6124 W PARKER RD STE G36
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093-8124
Mailing Address - Country:US
Mailing Address - Phone:972-981-3107
Mailing Address - Fax:
Practice Address - Street 1:6124 W PARKER RD STE G36
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-8124
Practice Address - Country:US
Practice Address - Phone:972-981-3107
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-02
Last Update Date:2021-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXR6063207ZC0500X, 207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
No207ZC0500XAllopathic & Osteopathic PhysiciansPathologyCytopathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1053373894Medicaid