Provider Demographics
NPI:1477236727
Name:KELLOGG, ALEXANDRA KRISTINE (PA-C)
Entity type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:KRISTINE
Last Name:KELLOGG
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5560 SHASTA LN APT 44
Mailing Address - Street 2:
Mailing Address - City:LA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:91942-4410
Mailing Address - Country:US
Mailing Address - Phone:619-840-4756
Mailing Address - Fax:
Practice Address - Street 1:6136 LAKE MURRAY BLVD
Practice Address - Street 2:
Practice Address - City:LA MESA
Practice Address - State:CA
Practice Address - Zip Code:91942-2502
Practice Address - Country:US
Practice Address - Phone:877-693-6266
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-11
Last Update Date:2025-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA65973363A00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program