Provider Demographics
NPI:1194524991
Name:ANDERSON, ALEXANDRIA MICHELLE (CNP)
Entity type:Individual
Prefix:
First Name:ALEXANDRIA
Middle Name:MICHELLE
Last Name:ANDERSON
Suffix:
Gender:
Credentials:CNP
Other - Prefix:
Other - First Name:ALEXANDRIA
Other - Middle Name:MICHELLE
Other - Last Name:DOWNHOUR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4132 KEATON CROSSING BLVD
Mailing Address - Street 2:
Mailing Address - City:O FALLON
Mailing Address - State:MO
Mailing Address - Zip Code:63368-8222
Mailing Address - Country:US
Mailing Address - Phone:636-244-3589
Mailing Address - Fax:
Practice Address - Street 1:4132 KEATON CROSSING BLVD
Practice Address - Street 2:
Practice Address - City:O FALLON
Practice Address - State:MO
Practice Address - Zip Code:63368-8222
Practice Address - Country:US
Practice Address - Phone:636-244-3589
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-12
Last Update Date:2025-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2025007537363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health