Healthcare Provider Details

I. General information

NPI: 1538794540
Provider Name (Legal Business Name): ALEXIS REID
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/10/2020
Last Update Date: 11/22/2021
Certification Date: 11/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 19TH ST S
BIRMINGHAM AL
35294-0001
US

IV. Provider business mailing address

607 HIGHWAY 76
WHITE HOUSE TN
37188-9206
US

V. Phone/Fax

Practice location:
  • Phone: 205-934-5526
  • Fax:
Mailing address:
  • Phone: 615-616-9415
  • Fax: 615-616-9416

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number1-152330
License Number StateAL
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number26936
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: