Provider Demographics
NPI:1992331490
Name:ANDERSON, ALEXANDRA LAINE
Entity type:Individual
Prefix:MS
First Name:ALEXANDRA
Middle Name:LAINE
Last Name:ANDERSON
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 1:499 DENHAM CV
Mailing Address - Street 2:
Mailing Address - City:COLLIERVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38017-2431
Mailing Address - Country:US
Mailing Address - Phone:901-412-0357
Mailing Address - Fax:
Practice Address - Street 1:1050 UNION UNIVERSITY DR
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:TN
Practice Address - Zip Code:38305-3656
Practice Address - Country:US
Practice Address - Phone:731-668-1818
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-16
Last Update Date:2022-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program