Provider Demographics
NPI:1356906648
Name:ALEXANDER, MIREYA
Entity type:Individual
Prefix:
First Name:MIREYA
Middle Name:
Last Name:ALEXANDER
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:PO BOX 1100
Mailing Address - Street 2:
Mailing Address - City:RAYMOND
Mailing Address - State:MS
Mailing Address - Zip Code:39154-1100
Mailing Address - Country:US
Mailing Address - Phone:601-613-3737
Mailing Address - Fax:601-965-0362
Practice Address - Street 1:1230 RAYMOND RD
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39204-4583
Practice Address - Country:US
Practice Address - Phone:601-613-3737
Practice Address - Fax:601-965-0362
Is Sole Proprietor?:No
Enumeration Date:2019-05-02
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator