Basic Information
| Provider Information | |||||||||
| NPI: | 1396207361 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BURCH | ||||||||
| FirstName: | ALEXANDER | ||||||||
| MiddleName: | STEVEN | ||||||||
| NamePrefix: | MR. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 312 NELSON DR | ||||||||
| Address2: | |||||||||
| City: | RIVER RIDGE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 701231943 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5045541349 | ||||||||
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| Practice Location | |||||||||
| Address1: | 121 N 20TH ST STE 6 | ||||||||
| Address2: | |||||||||
| City: | OPELIKA | ||||||||
| State: | AL | ||||||||
| PostalCode: | 368015454 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3347493385 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/01/2019 | ||||||||
| LastUpdateDate: | 01/15/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 01/15/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | RN149926 | LA | N | Nursing Service Providers | Registered Nurse | 363L00000X | 1-161504 | AL | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
No ID Information.