Provider Demographics
NPI:1194554931
Name:MICKLEWRIGHT, ALEXANDRA RAE (DNP, PMHNP-BC)
Entity type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:RAE
Last Name:MICKLEWRIGHT
Suffix:
Gender:F
Credentials:DNP, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:602 HALFPIPE ST UNIT C
Mailing Address - Street 2:
Mailing Address - City:BELGRADE
Mailing Address - State:MT
Mailing Address - Zip Code:59714-3577
Mailing Address - Country:US
Mailing Address - Phone:406-871-6119
Mailing Address - Fax:
Practice Address - Street 1:602 HALFPIPE ST UNIT C
Practice Address - Street 2:
Practice Address - City:BELGRADE
Practice Address - State:MT
Practice Address - Zip Code:59714-3577
Practice Address - Country:US
Practice Address - Phone:406-871-6119
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-30
Last Update Date:2024-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR10032847363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health