Provider Demographics
NPI:1992274765
Name:CROOKS, ALEXANDRIA MOTLEY
Entity type:Individual
Prefix:
First Name:ALEXANDRIA
Middle Name:MOTLEY
Last Name:CROOKS
Suffix:
Gender:F
Credentials:
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 60447
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-0447
Mailing Address - Country:US
Mailing Address - Phone:704-316-1055
Mailing Address - Fax:704-316-1056
Practice Address - Street 1:9929 REA RD STE 101
Practice Address - Street 2:
Practice Address - City:WAXHAW
Practice Address - State:NC
Practice Address - Zip Code:28173-6439
Practice Address - Country:US
Practice Address - Phone:704-316-1055
Practice Address - Fax:704-316-1056
Is Sole Proprietor?:No
Enumeration Date:2018-11-21
Last Update Date:2024-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5012073363L00000X, 363LF0000X
GARN282223363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner