Healthcare Provider Details

I. General information

NPI: 1164959888
Provider Name (Legal Business Name): ALEXIS NICOLIA HAUGHTON PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2017
Last Update Date: 08/21/2024
Certification Date: 08/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2527 GLEBE AVE
BRONX NY
10461-3109
US

IV. Provider business mailing address

2743 MORELAND ST
YORKTOWN HEIGHTS NY
10598-2420
US

V. Phone/Fax

Practice location:
  • Phone: 718-904-4400
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberF402256-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: