Provider Demographics
NPI:1760127914
Name:SALTERS, ALEXIS LASHELLE
Entity Type:Individual
Prefix:
First Name:ALEXIS
Middle Name:LASHELLE
Last Name:SALTERS
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 1:213 GULLEDGE ST APT B
Mailing Address - Street 2:
Mailing Address - City:MONCKS CORNER
Mailing Address - State:SC
Mailing Address - Zip Code:29461-3564
Mailing Address - Country:US
Mailing Address - Phone:843-425-7482
Mailing Address - Fax:
Practice Address - Street 1:213 GULLEDGE ST APT B
Practice Address - Street 2:
Practice Address - City:MONCKS CORNER
Practice Address - State:SC
Practice Address - Zip Code:29461-3564
Practice Address - Country:US
Practice Address - Phone:843-425-7482
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-02
Last Update Date:2022-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC167576376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC735714Medicaid
SC149722OtherNON EMT MEDICAL TRANSPORTATION SERVICES