MEDICARE: ALEXIS RYAN RICCIONE CRNP

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	SP024245	PA
2	363LF0000X	Family Nurse Practitioner	30208	SC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	15171368	OTHER		CAQH

General Provider Information

NPI Number	:	1538834056
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALEXIS RYAN RICCIONE CRNP

Provider Business Mailing Address
First Line	:	PO BOX 37643
Second Line	:
City	:	BELFAST
State	:	ME
Zip	:	04915-1218
Country	:	US
Telephone Number	:	843-682-7480
Fax Number	:

Provider Business Practice Location Address
First Line	:	40 OKATIE CENTER BLVD S STE 100
Second Line	:
City	:	OKATIE
State	:	SC
Zip	:	29909-7519
Country	:	US
Telephone Number	:	843-705-9145
Fax Number	:

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

Provider Enumeration Date	:	08/16/2021
Last Update Date	:	08/15/2025

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