Provider Demographics
NPI:1417509316
Name:PROSK, ALEXANDRA ANTHONY (MSN, APRN, PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:ANTHONY
Last Name:PROSK
Suffix:
Gender:F
Credentials:MSN, APRN, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:510 HEARN ST STE 100
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78703-4516
Mailing Address - Country:US
Mailing Address - Phone:210-861-1034
Mailing Address - Fax:512-521-0868
Practice Address - Street 1:510 HEARN ST STE 100
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78703-4516
Practice Address - Country:US
Practice Address - Phone:512-521-0868
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-10
Last Update Date:2019-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP142020363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health