Healthcare Provider Details

I. General information

NPI: 1154982346
Provider Name (Legal Business Name): ALEXIS LYKINS APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2019
Last Update Date: 02/11/2021
Certification Date: 02/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24110 MEADOWBROOK RD STE 105
NOVI MI
48375-3406
US

IV. Provider business mailing address

24110 MEADOWBROOK RD STE 105
NOVI MI
48375-3406
US

V. Phone/Fax

Practice location:
  • Phone: 734-386-6527
  • Fax:
Mailing address:
  • Phone: 734-386-6527
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number080450-21
License Number StateNH
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number080450-23
License Number StateNH
# 3
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number4704368516
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: