Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Alexandra Lauren Pettus, NURSEPRACTITIONER

Individual provider Family Nurse Practitioner · NPI 1750148748

Alexandra Lauren Pettus, NURSEPRACTITIONER is a Nurse Practitioner in San Bernardino, California. Qualified in 2024, 2 years ago. Practices as a sole proprietor. Licensed in California.

Years since qualifying
2
Licensed in
CA
In the registry since
2024
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Practice location Address checks out

1800 Western Ave Ste 204
San Bernardino, CA 92411-1353
Phone: (909) 474-9952
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Family Nurse Practitioner (primary) Taxonomy 363LF0000X · Licence 95028213 (CA)

Record details

NPI number1750148748
Entity typeIndividual (Type 1)
GenderFemale
Credentials NURSEPRACTITIONER
Sole proprietorYes
NPI enumeratedMarch 5, 2024
Last updated in NPPESMarch 5, 2024
Certification dateMarch 3, 2024

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyNURSE PRACTITIONER
Medical schoolOTHER
Graduated 2024 (2 years in practice)
Accepts Medicare assignment Not indicated
Practice locations3 on file with Medicare

Other providers in San Bernardino