Healthcare Provider Details

I. General information

NPI: 1699951178
Provider Name (Legal Business Name): ALEXIS GARRETSON HODGES FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/15/2008
Last Update Date: 06/18/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4923 S CROATAN HWY OUTER BANKS URGENT CARE AND FAMILY PRACTICE
NAGS HEAD NC
27959-9709
US

IV. Provider business mailing address

1134 N ROAD ST STE 9 MEDICAL SERVICES OF THE ALBEMARLE
ELIZABETH CITY NC
27909-3365
US

V. Phone/Fax

Practice location:
  • Phone: 252-261-8040
  • Fax: 252-441-7041
Mailing address:
  • Phone: 252-338-9451
  • Fax: 252-338-9170

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0050-03866
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number5003866
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: