Provider Demographics
NPI:1831954866
Name:SHELL, ALEXUS (OWNER)
Entity type:Individual
Prefix:
First Name:ALEXUS
Middle Name:
Last Name:SHELL
Suffix:
Gender:F
Credentials:OWNER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3996 E SERVICE RD APT 182
Mailing Address - Street 2:
Mailing Address - City:WEST MEMPHIS
Mailing Address - State:AR
Mailing Address - Zip Code:72301-5091
Mailing Address - Country:US
Mailing Address - Phone:870-225-3650
Mailing Address - Fax:
Practice Address - Street 1:3996 E SERVICE RD APT 182
Practice Address - Street 2:
Practice Address - City:WEST MEMPHIS
Practice Address - State:AR
Practice Address - Zip Code:72301-5091
Practice Address - Country:US
Practice Address - Phone:870-225-3650
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-19
Last Update Date:2024-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR3747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant