MEDICARE: ALEXIS C ALLEN 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	1-126654	AL

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

General Provider Information

NPI Number	:	1659764157
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALEXIS C ALLEN CRNP

Provider Business Mailing Address
First Line	:	PO BOX 2699
Second Line	:
City	:	PENSACOLA
State	:	FL
Zip	:	32513-2699
Country	:	US
Telephone Number	:	850-475-4686
Fax Number	:	850-475-4619

Provider Business Practice Location Address
First Line	:	5100 RANGELINE RD. NORTH
Second Line	:
City	:	MOBILE
State	:	AL
Zip	:	36608-9504
Country	:	US
Telephone Number	:	251-661-4454
Fax Number	:

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

Provider Enumeration Date	:	03/09/2015
Last Update Date	:	06/03/2019

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