Provider Demographics
NPI:1740028091
Name:WILLETT, ALEXANDER WADE
Entity type:Individual
Prefix:
First Name:ALEXANDER
Middle Name:WADE
Last Name:WILLETT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:49 COLLINS LN
Mailing Address - Street 2:
Mailing Address - City:CLEARFIELD
Mailing Address - State:KY
Mailing Address - Zip Code:40313-9785
Mailing Address - Country:US
Mailing Address - Phone:606-369-0169
Mailing Address - Fax:
Practice Address - Street 1:780 ROSE ST
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40536-0001
Practice Address - Country:US
Practice Address - Phone:859-323-5261
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-18
Last Update Date:2024-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program