Individual
ALEXANDRA L BOURCY-CRANDELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1503 HIGHWAY 45 N, COLUMBUS, MS 39705-2113
(662) 328-9623
Mailing address
29 FRIAR TUCK CIR, COLUMBUS, MS 39705-3012
(585) 698-0967
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
PA56628
CA
363A00000X
Physician Assistant
PA56628
CA
363A00000X
Physician Assistant
—
—
363AM0700X
Medical Physician Assistant
Primary
PA00673
MS
363AM0700X
Medical Physician Assistant
PA56628
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PA00673
MS MEDICAL BOARD
MS
01
—
PA56628
STATE OF CALIFORNIA DCA
CA
Enumeration date
10/27/2018
Last updated
09/26/2022
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