Healthcare Provider Details

I. General information

NPI: 1376998021
Provider Name (Legal Business Name): ALEXIS LIGHTEN WESLEY M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ALEXIS NICOLE LIGHTEN M.D.

II. Dates (important events)

Enumeration Date: 05/02/2016
Last Update Date: 04/03/2023
Certification Date: 04/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6430 ROCKLEDGE DR STE 400
BETHESDA MD
20817-1847
US

IV. Provider business mailing address

2120 L STREET NW SUITE 600
WASHINGTON DC
20037
US

V. Phone/Fax

Practice location:
  • Phone: 301-881-9464
  • Fax:
Mailing address:
  • Phone: 914-714-9128
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberMD045728
License Number StateDC
# 3
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number0101270413
License Number StateVA
# 4
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberD0090129
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: