Provider Demographics
NPI:1316272016
Name:ALEXANDER, JODY FULTON (PA)
Entity type:Individual
Prefix:
First Name:JODY
Middle Name:FULTON
Last Name:ALEXANDER
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 848
Mailing Address - Street 2:PO BOX 848
Mailing Address - City:MARS
Mailing Address - State:PA
Mailing Address - Zip Code:16046-0848
Mailing Address - Country:US
Mailing Address - Phone:724-625-3171
Mailing Address - Fax:
Practice Address - Street 1:136 RICHARD DR
Practice Address - Street 2:
Practice Address - City:GLENSHAW
Practice Address - State:PA
Practice Address - Zip Code:15116-1200
Practice Address - Country:US
Practice Address - Phone:724-625-3171
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-10-14
Last Update Date:2009-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP010560363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily