Provider Demographics
NPI:1093079477
Name:FREDERICK, ALEXIS TAYLOR (MSN, CEN, ACNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:ALEXIS
Middle Name:TAYLOR
Last Name:FREDERICK
Suffix:
Gender:F
Credentials:MSN, CEN, ACNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2920 BROOKEVALE CT
Mailing Address - Street 2:
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30004-8466
Mailing Address - Country:US
Mailing Address - Phone:850-445-5640
Mailing Address - Fax:
Practice Address - Street 1:80 JESSIE HILL JR DRIVE SE
Practice Address - Street 2:GRADY MEMORIAL HOSPITAL
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30303
Practice Address - Country:US
Practice Address - Phone:404-752-1500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-29
Last Update Date:2012-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN178750363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care