Provider Demographics
NPI:1053520106
Name:ALEXANDER, KATHRINA ANDREA ELAINE (MD)
Entity type:Individual
Prefix:
First Name:KATHRINA
Middle Name:ANDREA ELAINE
Last Name:ALEXANDER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4619 KENNY RD
Mailing Address - Street 2:FML-CRED
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43220-2779
Mailing Address - Country:US
Mailing Address - Phone:614-457-8180
Mailing Address - Fax:614-583-3300
Practice Address - Street 1:1801 W 32ND ST BLDG B
Practice Address - Street 2:
Practice Address - City:JOPLIN
Practice Address - State:MO
Practice Address - Zip Code:64804-1528
Practice Address - Country:US
Practice Address - Phone:417-623-6330
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-22
Last Update Date:2015-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL28493207ZP0102X
MO2012005491207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL130774Medicaid
AL051119556OtherBCBS
AL130745Medicaid
AL051119555OtherBCBS
AL130744Medicaid
ALZ21033OtherVIVA
MS01672218Medicaid
AL051119554OtherBCBS
AL051119556OtherBCBS
ALZ21033OtherVIVA