Individual
ALEXANDRA NICOLE MYCOCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
890 W FARIS RD STE 100, GREENVILLE, SC 29605-4285
(864) 455-2888
(864) 455-2885
Mailing address
300 E MCBEE AVE FL 4, GREENVILLE, SC 29601-2842
(864) 522-2603
(864) 455-2885
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
4805
SC
363AM0700X
Medical Physician Assistant
PA4805
SC
Other
Enumeration date
01/16/2023
Last updated
01/14/2026
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