Provider Demographics
NPI:1245213586
Name:ALEXANDER, SHERRY A (PAC)
Entity type:Individual
Prefix:
First Name:SHERRY
Middle Name:A
Last Name:ALEXANDER
Suffix:
Gender:F
Credentials:PAC
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 989
Mailing Address - Street 2:
Mailing Address - City:EDEN
Mailing Address - State:TX
Mailing Address - Zip Code:76837-0989
Mailing Address - Country:US
Mailing Address - Phone:325-869-5500
Mailing Address - Fax:325-869-5692
Practice Address - Street 1:216 E COLLEGE
Practice Address - Street 2:
Practice Address - City:MASON
Practice Address - State:TX
Practice Address - Zip Code:76856-1390
Practice Address - Country:US
Practice Address - Phone:325-347-5926
Practice Address - Fax:325-347-5331
Is Sole Proprietor?:No
Enumeration Date:2005-11-21
Last Update Date:2012-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA01694363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8D2554Medicare PIN
S61679Medicare UPIN