Provider Demographics
NPI:1295541126
Name:WARD, ALEXUS ADRIANNA (CPNP)
Entity type:Individual
Prefix:
First Name:ALEXUS
Middle Name:ADRIANNA
Last Name:WARD
Suffix:
Gender:
Credentials:CPNP
Other - Prefix:
Other - First Name:ALEXUS
Other - Middle Name:
Other - Last Name:PEPIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 933432
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44193-0039
Mailing Address - Country:US
Mailing Address - Phone:937-641-5072
Mailing Address - Fax:
Practice Address - Street 1:5450 FAR HILLS AVE STE 110
Practice Address - Street 2:
Practice Address - City:KETTERING
Practice Address - State:OH
Practice Address - Zip Code:45429-2346
Practice Address - Country:US
Practice Address - Phone:937-436-2866
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-05
Last Update Date:2025-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0036995363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0093103Medicaid