Provider Demographics
NPI:1053979989
Name:CLARK, ALEXANDRA G (ANP)
Entity type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:G
Last Name:CLARK
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:909 HIDDEN RDG STE 300
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75038-3801
Mailing Address - Country:US
Mailing Address - Phone:469-776-6222
Mailing Address - Fax:866-322-2309
Practice Address - Street 1:909 HIDDEN RDG STE 300
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75038-3801
Practice Address - Country:US
Practice Address - Phone:469-776-6222
Practice Address - Fax:866-322-2309
Is Sole Proprietor?:No
Enumeration Date:2019-06-05
Last Update Date:2024-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP139055363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXAP139055OtherLICENSE