Provider Demographics
NPI:1851007868
Name:ALEXANDER, KATINA ANN (FNP-C)
Entity Type:Individual
Prefix:
First Name:KATINA
Middle Name:ANN
Last Name:ALEXANDER
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:603 CHURCH STREET
Mailing Address - Street 2:
Mailing Address - City:LAURENS, SC
Mailing Address - State:SC
Mailing Address - Zip Code:29360-1718
Mailing Address - Country:US
Mailing Address - Phone:864-872-3696
Mailing Address - Fax:864-509-0750
Practice Address - Street 1:603 CHURCH STREET
Practice Address - Street 2:
Practice Address - City:LAURENS, SC
Practice Address - State:SC
Practice Address - Zip Code:29360
Practice Address - Country:US
Practice Address - Phone:864-872-3696
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-24
Last Update Date:2023-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC25853363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner