Healthcare Provider Details

I. General information

NPI: 1427339167
Provider Name (Legal Business Name): ALEXIS STORY HATCH FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/08/2011
Last Update Date: 06/05/2023
Certification Date: 06/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3933 E EDNA AVE
PHOENIX AZ
85032-2127
US

IV. Provider business mailing address

1519 E VILLA THERESA DR
PHOENIX AZ
85022-1280
US

V. Phone/Fax

Practice location:
  • Phone: 602-569-5437
  • Fax:
Mailing address:
  • Phone: 603-475-2616
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number291335
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number289480
License Number StateMA
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number064600-21
License Number StateNH
# 4
Primary TaxonomyN
Taxonomy Code246Z00000X
TaxonomyOther Specialist/Technologist
License Number8158
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: