Basic Information
Provider Information
NPI: 1659444933
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: ALEXANDER
FirstName: STEFANI
MiddleName: P
NamePrefix: MS.
NameSuffix:  
Credential: PAC
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 7777 FOREST LN
Address2: SUITE C 833
City: DALLAS
State: TX
PostalCode: 752302584
CountryCode: US
TelephoneNumber: 9725664591
FaxNumber: 9725666679
Practice Location
Address1: 7777 FOREST LANE
Address2: C833
City: DALLAS
State: TX
PostalCode: 75230
CountryCode: US
TelephoneNumber: 2145664591
FaxNumber:  
Other Information
ProviderEnumerationDate: 11/16/2006
LastUpdateDate: 04/15/2011
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363A00000XPA01690TXY Physician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant 

No ID Information.


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