Healthcare Provider Details

I. General information

NPI: 1407772338
Provider Name (Legal Business Name): ALEXIS MCCONVILLE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/25/2026
Last Update Date: 06/25/2026
Certification Date: 06/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1901 ATHERHOLT RD
LYNCHBURG VA
24501-1103
US

IV. Provider business mailing address

203 SIMSBURY LN
FOREST VA
24551-2610
US

V. Phone/Fax

Practice location:
  • Phone: 919-634-0605
  • Fax:
Mailing address:
  • Phone: 919-634-0605
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number0001338385
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: