Basic Information
| Provider Information | |||||||||
| NPI: | 1275093742 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WADE | ||||||||
| FirstName: | ALEXANDER | ||||||||
| MiddleName: | HYKLE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2195 HARRODSBURG RD | ||||||||
| Address2: | |||||||||
| City: | LEXINGTON | ||||||||
| State: | KY | ||||||||
| PostalCode: | 405043504 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8593236712 | ||||||||
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| Practice Location | |||||||||
| Address1: | 100 PROVIDENCE WAY STE 200 | ||||||||
| Address2: | |||||||||
| City: | NICHOLASVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 403566033 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8592605370 | ||||||||
| FaxNumber: | 8592605379 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/21/2019 | ||||||||
| LastUpdateDate: | 06/21/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/21/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | KY | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 207Q00000X | 56498 | KY | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.