[1] She was also a notable member of the United Daughters of the Confederacy; it was an association for the advocacy of the Lost Cause ideology upheld the idea of white supremacy.

The following year, she obtained her license to practice medicine from the Maryland Board of Medical Examiners, earning the highest grade among 100 candidates.

She returned to Mecklenburg County in 1887 to practice medicine,[5] and in 1889 she bought a home in Charlotte, North Carolina.

[6] Alexander worked as a physician at the Presbyterian College for Women (now Queens University of Charlotte) for twenty-three years.

[3] During World War I, Alexander was a first lieutenant in the United States Army[1] and was appointed acting assistant surgeon at Camp Greene in Charlotte, where she performed medical inspections of the school children and grappled with the devastation wrought by the 1918 flu pandemic.