Healthcare Provider Details

I. General information

NPI: 1891095451
Provider Name (Legal Business Name): ALESIA ROCHALE TRAEYE NIX DNP, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/29/2010
Last Update Date: 11/20/2024
Certification Date: 11/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3841 COVENTRY DR
VALDOSTA GA
31605-7968
US

IV. Provider business mailing address

3841 COVENTRY DR
VALDOSTA GA
31605-7968
US

V. Phone/Fax

Practice location:
  • Phone: 352-246-5917
  • Fax:
Mailing address:
  • Phone: 352-246-5917
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN9336508
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberGAA-NP001077
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: