Provider Demographics
NPI:1508216342
Name:MIDDLETON, ALEXA (NP-C)
Entity Type:Individual
Prefix:MRS
First Name:ALEXA
Middle Name:
Last Name:MIDDLETON
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 743294
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-3294
Mailing Address - Country:US
Mailing Address - Phone:269-503-4379
Mailing Address - Fax:
Practice Address - Street 1:BON SECOURS COVENANT PRIMARY CARE
Practice Address - Street 2:10 ENTERPRISE BLVD., STE 111
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29615-4850
Practice Address - Country:US
Practice Address - Phone:864-365-0200
Practice Address - Fax:877-893-3772
Is Sole Proprietor?:No
Enumeration Date:2016-06-13
Last Update Date:2018-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC21876363LF0000X
MI4703102370363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCNP5292Medicaid