Provider Demographics
NPI:1982799466
Name:ALEXANDER, JACKIE LEA (RN, APN)
Entity Type:Individual
Prefix:MS
First Name:JACKIE
Middle Name:LEA
Last Name:ALEXANDER
Suffix:
Gender:F
Credentials:RN, APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1500 E 2ND ST
Mailing Address - Street 2:SUITE 206
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89502-1181
Mailing Address - Country:US
Mailing Address - Phone:775-789-7000
Mailing Address - Fax:775-789-7040
Practice Address - Street 1:1500 E 2ND ST
Practice Address - Street 2:SUITE 206
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89502-1181
Practice Address - Country:US
Practice Address - Phone:775-789-7000
Practice Address - Fax:775-789-7040
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVAPN00755363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV100502922Medicaid
NVAPN00755OtherAPN NUMBER
NVAPN00652OtherPRESCRIPTIVE AUTHORITY
NVAPN00652OtherPRESCRIPTIVE AUTHORITY
NVS61503Medicare UPIN
NVMA1231872OtherDEA NUMBER