Healthcare Provider Details

I. General information

NPI: 1700492873
Provider Name (Legal Business Name): ALEXIS MARIE SIMPSON FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/23/2020
Last Update Date: 10/25/2024
Certification Date: 10/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7041 LEE PARK RD
MECHANICSVILLE VA
23111-3682
US

IV. Provider business mailing address

4900 COX RD STE 155
GLEN ALLEN VA
23060-6507
US

V. Phone/Fax

Practice location:
  • Phone: 804-746-3505
  • Fax: 804-730-8038
Mailing address:
  • Phone: 804-726-8571
  • Fax: 804-726-8574

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0024179985
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number0001221296
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number0024179985
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: