Provider Demographics
NPI:1922720101
Name:LUMPKIN, ALEXIS SHAVONE (NURSE)
Entity Type:Individual
Prefix:
First Name:ALEXIS
Middle Name:SHAVONE
Last Name:LUMPKIN
Suffix:
Gender:F
Credentials:NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 CANEBRAKE BLVD STE 203
Mailing Address - Street 2:
Mailing Address - City:FLOWOOD
Mailing Address - State:MS
Mailing Address - Zip Code:39232-2211
Mailing Address - Country:US
Mailing Address - Phone:601-850-4579
Mailing Address - Fax:
Practice Address - Street 1:5201 LAKELAND BLVD APT S192
Practice Address - Street 2:
Practice Address - City:FLOWOOD
Practice Address - State:MS
Practice Address - Zip Code:39232-8916
Practice Address - Country:US
Practice Address - Phone:601-850-4579
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-14
Last Update Date:2022-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS323078164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse