MEDICARE: ALEXIS VIKKETTA EDWARDS FNP-BC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	5018106	NC

General Provider Information

NPI Number	:	1356032031
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALEXIS VIKKETTA EDWARDS FNP-BC

Provider Business Mailing Address
First Line	:	317 ORCHARD DR
Second Line	:
City	:	ELIZABETH CITY
State	:	NC
Zip	:	27909-9324
Country	:	US
Telephone Number	:	252-455-2443
Fax Number	:

Provider Business Practice Location Address
First Line	:	902B ROANOKE AVE
Second Line	:
City	:	ELIZABETH CITY
State	:	NC
Zip	:	27909-5565
Country	:	US
Telephone Number	:	252-368-8575
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/15/2023
Last Update Date	:	03/11/2026

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