Provider Demographics
NPI:1053110916
Name:PHILLIPS, ALEXIS MARIE (APRN-CNP)
Entity type:Individual
Prefix:
First Name:ALEXIS
Middle Name:MARIE
Last Name:PHILLIPS
Suffix:
Gender:
Credentials:APRN-CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:690 PANAMA DR
Mailing Address - Street 2:
Mailing Address - City:SPARKS
Mailing Address - State:NV
Mailing Address - Zip Code:89436-1875
Mailing Address - Country:US
Mailing Address - Phone:209-814-7876
Mailing Address - Fax:
Practice Address - Street 1:SUMMIT PEDIATRICS
Practice Address - Street 2:6350 MAE ANNE AVE #3
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89523
Practice Address - Country:US
Practice Address - Phone:775-624-6350
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-12
Last Update Date:2025-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV827111363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner