Provider Demographics
NPI:1053000927
Name:WOOLERY, ALEXA-GAIL RUTH-ANN
Entity type:Individual
Prefix:
First Name:ALEXA-GAIL
Middle Name:RUTH-ANN
Last Name:WOOLERY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1830 GINGERCAKE CIR APT 203
Mailing Address - Street 2:
Mailing Address - City:ROCK HILL
Mailing Address - State:SC
Mailing Address - Zip Code:29732-7434
Mailing Address - Country:US
Mailing Address - Phone:803-389-1497
Mailing Address - Fax:
Practice Address - Street 1:1040 EDGEWATER CORPORATE PKWY
Practice Address - Street 2:
Practice Address - City:INDIAN LAND
Practice Address - State:SC
Practice Address - Zip Code:29707-4514
Practice Address - Country:US
Practice Address - Phone:803-548-7007
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-05
Last Update Date:2023-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC27289363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily