Healthcare Provider Details

I. General information

NPI: 1811786742
Provider Name (Legal Business Name): ALEXIS BEAL MSN, APRN, AGCNS-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/06/2025
Last Update Date: 06/12/2025
Certification Date: 06/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1320 MERCY DR NW
CANTON OH
44708-2614
US

IV. Provider business mailing address

1320 MERCY DR NW # MCY5-108
CANTON OH
44708-2614
US

V. Phone/Fax

Practice location:
  • Phone: 330-489-4423
  • Fax:
Mailing address:
  • Phone: 330-844-9576
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364S00000X
TaxonomyClinical Nurse Specialist
License NumberAPRN.CNS.0019544
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: