Provider Demographics
NPI:1356032031
Name:EDWARDS, ALEXIS VIKKETTA (FNP-BC)
Entity type:Individual
Prefix:
First Name:ALEXIS
Middle Name:VIKKETTA
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:317 ORCHARD DR
Mailing Address - Street 2:
Mailing Address - City:ELIZABETH CITY
Mailing Address - State:NC
Mailing Address - Zip Code:27909-9324
Mailing Address - Country:US
Mailing Address - Phone:252-455-2443
Mailing Address - Fax:
Practice Address - Street 1:902B ROANOKE AVE
Practice Address - Street 2:
Practice Address - City:ELIZABETH CITY
Practice Address - State:NC
Practice Address - Zip Code:27909-5565
Practice Address - Country:US
Practice Address - Phone:252-368-8575
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-15
Last Update Date:2023-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCEDWA-MGI7Q363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily