Provider Demographics
NPI:1851070932
Name:ALEXIS, WAYNE JR
Entity Type:Individual
Prefix:MR
First Name:WAYNE
Middle Name:
Last Name:ALEXIS
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14353 BLUFF PASS DR
Mailing Address - Street 2:
Mailing Address - City:PRAIRIEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70769-3287
Mailing Address - Country:US
Mailing Address - Phone:225-363-0118
Mailing Address - Fax:
Practice Address - Street 1:14353 BLUFF PASS DR
Practice Address - Street 2:
Practice Address - City:PRAIRIEVILLE
Practice Address - State:LA
Practice Address - Zip Code:70769-3287
Practice Address - Country:US
Practice Address - Phone:225-363-0118
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-14
Last Update Date:2023-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA007199518172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver