Healthcare Provider Details

I. General information

NPI: 1972418622
Provider Name (Legal Business Name): ALESIA ELLEN SHAVIS FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/17/2026
Last Update Date: 08/17/2026
Certification Date: 08/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3526 CARRERA CT
HIGH POINT NC
27265-8733
US

IV. Provider business mailing address

3526 CARRERA CT 3526 CARRERA COURT
HIGH POINT NC
27265-8733
US

V. Phone/Fax

Practice location:
  • Phone: 336-455-0617
  • Fax: 336-455-0617
Mailing address:
  • Phone: 336-455-0617
  • Fax: 336-455-0617

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number153508
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: