Provider Demographics
NPI:1578506994
Name:ALEXANDER, ANDREA ALICIA (WHNP)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:ALICIA
Last Name:ALEXANDER
Suffix:
Gender:F
Credentials:WHNP
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 743904
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-3904
Mailing Address - Country:US
Mailing Address - Phone:803-296-7320
Mailing Address - Fax:803-296-7330
Practice Address - Street 1:5336 SUNSET BLVD STE A
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:SC
Practice Address - Zip Code:29072-9393
Practice Address - Country:US
Practice Address - Phone:803-567-8900
Practice Address - Fax:803-567-8909
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2023-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1446363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCNP0666Medicaid
SCSC32019505Medicare PIN
RISC3201F935Medicare PIN
SCP862087951Medicare PIN
SCP862083640Medicare PIN
SCP86208Medicare UPIN
SCSC32013922Medicare PIN