Provider Demographics
NPI:1013614593
Name:DECARR, ALEXA RAE
Entity type:Individual
Prefix:
First Name:ALEXA
Middle Name:RAE
Last Name:DECARR
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 1:6 BUSINESS PARK CT
Mailing Address - Street 2:
Mailing Address - City:UTICA
Mailing Address - State:NY
Mailing Address - Zip Code:13502-6309
Mailing Address - Country:US
Mailing Address - Phone:315-451-5400
Mailing Address - Fax:315-624-9084
Practice Address - Street 1:6 BUSINESS PARK CT
Practice Address - Street 2:
Practice Address - City:UTICA
Practice Address - State:NY
Practice Address - Zip Code:13502-6309
Practice Address - Country:US
Practice Address - Phone:315-451-5400
Practice Address - Fax:315-624-9084
Is Sole Proprietor?:No
Enumeration Date:2023-02-14
Last Update Date:2025-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY033153363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant