Provider Demographics
NPI:1205654829
Name:BUMGARNER, ALEXA ROSE
Entity type:Individual
Prefix:
First Name:ALEXA
Middle Name:ROSE
Last Name:BUMGARNER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1039 FRIENDLY GROVE CHURCH RD
Mailing Address - Street 2:
Mailing Address - City:MILLERS CREEK
Mailing Address - State:NC
Mailing Address - Zip Code:28651-9144
Mailing Address - Country:US
Mailing Address - Phone:336-469-9197
Mailing Address - Fax:
Practice Address - Street 1:1039 FRIENDLY GROVE CHURCH RD
Practice Address - Street 2:
Practice Address - City:MILLERS CREEK
Practice Address - State:NC
Practice Address - Zip Code:28651-9144
Practice Address - Country:US
Practice Address - Phone:336-469-9197
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-02
Last Update Date:2024-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant