Healthcare Provider Details

I. General information

NPI: 1952227654
Provider Name (Legal Business Name): ALEXIS RENEE GOODE RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ALEXIS RENEE MCCONNELL

II. Dates (important events)

Enumeration Date: 06/26/2026
Last Update Date: 06/26/2026
Certification Date: 06/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 CENTRAL AVE SE
ALBUQUERQUE NM
87106-4934
US

IV. Provider business mailing address

1200 VISTA DE BOSQUE SW
LOS LUNAS NM
87031-8981
US

V. Phone/Fax

Practice location:
  • Phone: 505-841-1234
  • Fax:
Mailing address:
  • Phone: 505-715-8091
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WW0101X
TaxonomyAmbulatory Women's Health Care Registered Nurse
License Number65589
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: