Provider Demographics
NPI:1578254918
Name:STROUD, ALEXIS MACKENZIE
Entity Type:Individual
Prefix:
First Name:ALEXIS
Middle Name:MACKENZIE
Last Name:STROUD
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 1:4144 STATE ROUTE 235 N
Mailing Address - Street 2:
Mailing Address - City:LEWISTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:43333-9736
Mailing Address - Country:US
Mailing Address - Phone:937-935-5723
Mailing Address - Fax:
Practice Address - Street 1:4144 STATE ROUTE 235 N
Practice Address - Street 2:
Practice Address - City:LEWISTOWN
Practice Address - State:OH
Practice Address - Zip Code:43333-9736
Practice Address - Country:US
Practice Address - Phone:937-935-5723
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-17
Last Update Date:2023-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide