Provider Demographics
NPI:1235215633
Name:ALEXANDER, JENNIFER L (PA)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:L
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 1:2101 N AMERICA RD
Mailing Address - Street 2:
Mailing Address - City:GALATIA
Mailing Address - State:IL
Mailing Address - Zip Code:62935-2579
Mailing Address - Country:US
Mailing Address - Phone:618-992-3272
Mailing Address - Fax:618-992-3273
Practice Address - Street 1:1009 W MAIN ST
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:IL
Practice Address - Zip Code:62959-1841
Practice Address - Country:US
Practice Address - Phone:618-992-3272
Practice Address - Fax:618-992-3273
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-27
Last Update Date:2025-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL085001985363A00000X
KS15-02563363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL204996Medicare ID - Type Unspecified
P83081Medicare UPIN