Provider Demographics
NPI:1184246449
Name:ACKERMAN, ALIX (APRN, NP-C)
Entity type:Individual
Prefix:
First Name:ALIX
Middle Name:
Last Name:ACKERMAN
Suffix:
Gender:F
Credentials:APRN, NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 68
Mailing Address - Street 2:
Mailing Address - City:POLLOCKSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28573-0068
Mailing Address - Country:US
Mailing Address - Phone:252-244-1785
Mailing Address - Fax:252-244-2876
Practice Address - Street 1:620 FARM LIFE AVE
Practice Address - Street 2:
Practice Address - City:VANCEBORO
Practice Address - State:NC
Practice Address - Zip Code:28586-7673
Practice Address - Country:US
Practice Address - Phone:252-244-1785
Practice Address - Fax:252-244-2876
Is Sole Proprietor?:No
Enumeration Date:2020-05-10
Last Update Date:2020-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5013184363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health