Alisa Jocelyn Alexander, M.D.
Individual provider Active NPI Family Medicine Physician · Fairbanks, AK
NPI 1215207253 · NPPES record last updated Dec 20, 2016
Key facts
- NPI
- 1215207253
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- 7468 (AK)
- Practice address
- 1717 W Cowles St
Fairbanks, AK 99701-5926 - Phone
- (907) 451-6682
- Fax
- (907) 459-3811
- NPI assigned
- Jan 9, 2012
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in TX
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20150102000681 | TX | Practitioner - Family Practice | 2365765187 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 7468 | AK | MD | Family Medicine Physician |
Interoperability endpoints
- alisa.alexander.1@15989.direct.athenahealth.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 7468 | AK | Yes |
Addresses
Primary practice location
1717 W Cowles St
Fairbanks, AK 99701-5926
Mailing address
1717 W Cowles St
Fairbanks, AK 99701-5926
Phone (907) 451-6682
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| MEDS7468 | Other | AK | ALASKA STATE LICENSE |
| 1579583 | Medicaid | AK |
Other names
- Alisa Jocelyn Kelly
Other providers in Fairbanks, AK
- Alchemy Orthotics and Prosthetics
- Betty Jane Aldrich
- Justin Alapasa Aleki
- Sara Georgina Aleksandravicius
- Alesia Assisted Living LLC
- Gregory Charles Alexander
- Hannah Micaela Alexander
- Laverne L Alexander
- Sierra Alexander
- Alfred D Deramus MD a Professional Corporation
All providers in Fairbanks, AK · Family Medicine Physician in Alaska
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 20, 2016. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.