Provider Demographics
NPI:1912249343
Name:ALEXANDER, KELVINNA MCLEMORE (NP-C)
Entity Type:Individual
Prefix:
First Name:KELVINNA
Middle Name:MCLEMORE
Last Name:ALEXANDER
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:KELVINNA
Other - Middle Name:R
Other - Last Name:MCCLEMORE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 1729
Mailing Address - Street 2:
Mailing Address - City:HATTIESBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39403-1729
Mailing Address - Country:US
Mailing Address - Phone:601-545-3700
Mailing Address - Fax:601-450-2493
Practice Address - Street 1:1911 READ RD
Practice Address - Street 2:
Practice Address - City:PICAYUNE
Practice Address - State:MS
Practice Address - Zip Code:39466-2730
Practice Address - Country:US
Practice Address - Phone:601-251-3500
Practice Address - Fax:601-251-3504
Is Sole Proprietor?:No
Enumeration Date:2013-03-24
Last Update Date:2024-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP07238363LF0000X
MSR875811363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS12587886OtherCAQH NUMBER
MS00377010Medicaid
MS3661624OtherUNITED HEALTH CARE PIN
MS00377010Medicaid