Provider Demographics
NPI:1013495167
Name:SMELLEY, ALEXIS MICHELLE
Entity Type:Individual
Prefix:
First Name:ALEXIS
Middle Name:MICHELLE
Last Name:SMELLEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ALEXIS
Other - Middle Name:MICHELLE
Other - Last Name:LYONS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7630 CHANTILLY ISLAND CT
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89123-1490
Mailing Address - Country:US
Mailing Address - Phone:804-909-1390
Mailing Address - Fax:
Practice Address - Street 1:7630 CHANTILLY ISLAND CT
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89123-1490
Practice Address - Country:US
Practice Address - Phone:804-909-1390
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-31
Last Update Date:2018-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management