Provider Demographics
NPI:1841052073
Name:HERNDON, ALEXANDRA PULASKI
Entity type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:PULASKI
Last Name:HERNDON
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:131 BRISBON HALL DR
Mailing Address - Street 2:
Mailing Address - City:RICHMOND HILL
Mailing Address - State:GA
Mailing Address - Zip Code:31324-8833
Mailing Address - Country:US
Mailing Address - Phone:912-656-3628
Mailing Address - Fax:
Practice Address - Street 1:101 ROBESON ST STE 200
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28301-5520
Practice Address - Country:US
Practice Address - Phone:910-615-1860
Practice Address - Fax:910-615-9630
Is Sole Proprietor?:No
Enumeration Date:2024-01-24
Last Update Date:2025-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAF01240808363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily