1699951178 NPI number — MS. ALEXIS GARRETSON HODGES FNP

Table of content: MS. ALEXIS GARRETSON HODGES FNP (NPI 1699951178)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1699951178 NPI number — MS. ALEXIS GARRETSON HODGES FNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HODGES
Provider First Name:
ALEXIS
Provider Middle Name:
GARRETSON
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
FNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1699951178
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/18/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1134 N ROAD ST STE 9
Provider Second Line Business Mailing Address:
MEDICAL SERVICES OF THE ALBEMARLE
Provider Business Mailing Address City Name:
ELIZABETH CITY
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27909-3365
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
252-338-9451
Provider Business Mailing Address Fax Number:
252-338-9170

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4923 S CROATAN HWY
Provider Second Line Business Practice Location Address:
OUTER BANKS URGENT CARE AND FAMILY PRACTICE
Provider Business Practice Location Address City Name:
NAGS HEAD
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27959-9709
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
252-261-8040
Provider Business Practice Location Address Fax Number:
252-441-7041
Provider Enumeration Date:
01/15/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  0050-03866 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LF0000X , with the licence number: 5003866 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)