Healthcare Provider Details

I. General information

NPI: 1992398051
Provider Name (Legal Business Name): ALEXIS BRIDGES GLOVER FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/18/2021
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 N FREEPORT PKWY STE 1200
COPPELL TX
75019-3508
US

IV. Provider business mailing address

900 7TH ST SW APT 309
WASHINGTON DC
20024-2824
US

V. Phone/Fax

Practice location:
  • Phone: 855-673-2876
  • Fax:
Mailing address:
  • Phone: 404-401-1010
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN1028339
License Number StateDC
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR214046
License Number StateMD
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0024181281
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: