Basic Information
| Provider Information | |||||||||
| NPI: | 1831360411 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DUNCAN | ||||||||
| FirstName: | ALEXANDRIA | ||||||||
| MiddleName: | NICOLE | ||||||||
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| Credential: | WHANP-BC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3076 BARNES BEND DR | ||||||||
| Address2: | |||||||||
| City: | ANTIOCH | ||||||||
| State: | TN | ||||||||
| PostalCode: | 370134479 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6154000075 | ||||||||
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| Practice Location | |||||||||
| Address1: | 230 DOVER ROAD | ||||||||
| Address2: | |||||||||
| City: | CLARKSVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 37042 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9319205000 | ||||||||
| FaxNumber: | 9319205011 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/21/2008 | ||||||||
| LastUpdateDate: | 08/05/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LA2200X | APN0000013309 | TN | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Adult Health | 363LX0001X | 13309 | TN | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Obstetrics & Gynecology |
ID Information
| ID | Type | State | Issuer | Description | 3340187 | 05 | TN | MEDICAID |