Provider Demographics
NPI:1518585066
Name:ORANGE, ALEXANDREA BUNCH
Entity Type:Individual
Prefix:
First Name:ALEXANDREA
Middle Name:BUNCH
Last Name:ORANGE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5200 COMMERCE CROSSINGS DR FL FL
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40229-2182
Mailing Address - Country:US
Mailing Address - Phone:502-861-5278
Mailing Address - Fax:
Practice Address - Street 1:1720 NICHOLASVILLE RD STE 502
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40503-1487
Practice Address - Country:US
Practice Address - Phone:859-277-7129
Practice Address - Fax:859-277-9613
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-10
Last Update Date:2021-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
KYTC112363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program