Provider Demographics
NPI:1952736811
Name:ALEXANDER, MYLISSA BLAYNE (APRN, FNP-C)
Entity type:Individual
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First Name:MYLISSA
Middle Name:BLAYNE
Last Name:ALEXANDER
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Gender:F
Credentials:APRN, FNP-C
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Mailing Address - Street 1:PO BOX 733784
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75373-3784
Mailing Address - Country:US
Mailing Address - Phone:682-885-1855
Mailing Address - Fax:682-885-1396
Practice Address - Street 1:3906 E US HIGHWAY 377
Practice Address - Street 2:SUITE 100
Practice Address - City:GRANBURY
Practice Address - State:TX
Practice Address - Zip Code:76049-7608
Practice Address - Country:US
Practice Address - Phone:817-279-1390
Practice Address - Fax:817-573-5150
Is Sole Proprietor?:No
Enumeration Date:2013-09-11
Last Update Date:2021-04-14
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TX683870363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily