Provider Demographics
NPI:1639650476
Name:POPOVA, ALEXANDRA (RN,MSN)
Entity Type:Individual
Prefix:MS
First Name:ALEXANDRA
Middle Name:
Last Name:POPOVA
Suffix:
Gender:F
Credentials:RN,MSN
Other - Prefix:MS
Other - First Name:ALEXANDRA
Other - Middle Name:SERGEYVNA
Other - Last Name:POPOVA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RN, MSN
Mailing Address - Street 1:610 SYLVAN HEIGHTS WAY APT 245
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37209-4986
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:511 8TH ST
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37040-3093
Practice Address - Country:US
Practice Address - Phone:931-920-7200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-28
Last Update Date:2018-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000225458163WP0808X
TN25025363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health