Healthcare Provider Details

I. General information

NPI: 1336079359
Provider Name (Legal Business Name): ALEXIS DRAGOO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ALEXIS DRAGOO RN

II. Dates (important events)

Enumeration Date: 05/21/2026
Last Update Date: 05/21/2026
Certification Date: 05/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 E ASH ST BLDG 400
SPRINGFIELD IL
62703-2969
US

IV. Provider business mailing address

1424 SEQUOIA DR
CHATHAM IL
62629-8071
US

V. Phone/Fax

Practice location:
  • Phone: 217-782-4830
  • Fax:
Mailing address:
  • Phone: 217-691-1349
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number524770
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: