Provider Demographics
NPI:1568920700
Name:PRICE, ALEXIS RAELLE
Entity Type:Individual
Prefix:
First Name:ALEXIS
Middle Name:RAELLE
Last Name:PRICE
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 1:2240 SUGAR RUN RD
Mailing Address - Street 2:
Mailing Address - City:MILLWOOD
Mailing Address - State:WV
Mailing Address - Zip Code:25262-8614
Mailing Address - Country:US
Mailing Address - Phone:304-532-8969
Mailing Address - Fax:
Practice Address - Street 1:2240 SUGAR RUN RD
Practice Address - Street 2:
Practice Address - City:MILLWOOD
Practice Address - State:WV
Practice Address - Zip Code:25262-8614
Practice Address - Country:US
Practice Address - Phone:304-532-8969
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-06
Last Update Date:2019-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV246Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246Z00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, Other