MEDICARE: ALEXISS R WOOTEN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	374U00000X	Home Health Aide		OH

General Provider Information

NPI Number	:	1932067980
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALEXISS R WOOTEN

Provider Business Mailing Address
First Line	:	250 E 5TH ST
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45202-4119
Country	:	US
Telephone Number	:	513-596-6105
Fax Number	:

Provider Business Practice Location Address
First Line	:	455 W MCMICKEN AVE
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45214-3919
Country	:	US
Telephone Number	:	283-235-2269
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/09/2026
Last Update Date	:	01/09/2026

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Directions to “ ALEXISS R WOOTEN ” Practice Location

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