Provider Demographics
NPI:1003561291
Name:SIMS, ALEXIS M
Entity Type:Individual
Prefix:
First Name:ALEXIS
Middle Name:M
Last Name:SIMS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1311 RENAISSANCE CIR APT 314
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25311-1559
Mailing Address - Country:US
Mailing Address - Phone:304-982-4442
Mailing Address - Fax:
Practice Address - Street 1:1311 RENAISSANCE CIR APT 314
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25311-1559
Practice Address - Country:US
Practice Address - Phone:304-982-4442
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-16
Last Update Date:2022-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV3747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant