Provider Demographics
NPI:1730782731
Name:WILLIAMS, ALEXANDRA V (PA-C)
Entity type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:V
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:860 OMNI BLVD STE 112
Mailing Address - Street 2:
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23606-4430
Mailing Address - Country:US
Mailing Address - Phone:757-659-6287
Mailing Address - Fax:757-865-2845
Practice Address - Street 1:860 OMNI BLVD STE 112
Practice Address - Street 2:
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23606-4430
Practice Address - Country:US
Practice Address - Phone:757-659-6287
Practice Address - Fax:757-586-5284
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-20
Last Update Date:2023-07-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0110008035363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty