Provider Demographics
NPI:1699437020
Name:NELSEN, ALEXANDRIA SLOANE (PA-C)
Entity type:Individual
Prefix:MRS
First Name:ALEXANDRIA
Middle Name:SLOANE
Last Name:NELSEN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MISS
Other - First Name:ALEXANDRIA
Other - Middle Name:SLOANE
Other - Last Name:MCCUTCHAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:5022 LONGTOWN RD
Mailing Address - Street 2:
Mailing Address - City:RIDGEWAY
Mailing Address - State:SC
Mailing Address - Zip Code:29130-7117
Mailing Address - Country:US
Mailing Address - Phone:803-608-8999
Mailing Address - Fax:
Practice Address - Street 1:312 HARRISON BRIDGE RD
Practice Address - Street 2:
Practice Address - City:SIMPSONVILLE
Practice Address - State:SC
Practice Address - Zip Code:29680-7133
Practice Address - Country:US
Practice Address - Phone:864-603-5600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-13
Last Update Date:2024-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4135363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant