Provider Demographics
NPI:1205427820
Name:BARRE, ALEXANDRA ROSE (PA-C)
Entity type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:ROSE
Last Name:BARRE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:ALEXANDRA
Other - Middle Name:ROSE
Other - Last Name:JACKAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:9804 LOUGHLIN LN
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28273-4944
Mailing Address - Country:US
Mailing Address - Phone:704-807-4016
Mailing Address - Fax:
Practice Address - Street 1:6035 FAIRVIEW RD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28210-3256
Practice Address - Country:US
Practice Address - Phone:704-295-3045
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-27
Last Update Date:2023-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-11923363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant