Provider Demographics
NPI:1659018299
Name:LEVITT, ALEXIS S (APRN)
Entity Type:Individual
Prefix:
First Name:ALEXIS
Middle Name:S
Last Name:LEVITT
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:ALEXIS
Other - Middle Name:S
Other - Last Name:GRAHAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:PO BOX 372
Mailing Address - Street 2:
Mailing Address - City:MATTOON
Mailing Address - State:IL
Mailing Address - Zip Code:61938-0372
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2040 LINCOLN AVE STE 100
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:IL
Practice Address - Zip Code:61920-3197
Practice Address - Country:US
Practice Address - Phone:217-345-2030
Practice Address - Fax:217-345-2045
Is Sole Proprietor?:No
Enumeration Date:2022-05-16
Last Update Date:2024-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.025050363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily