Provider Demographics
NPI:1679094957
Name:SUTTLES, ALEXIS (FNP-C)
Entity type:Individual
Prefix:
First Name:ALEXIS
Middle Name:
Last Name:SUTTLES
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 STONEHAVEN DR
Mailing Address - Street 2:
Mailing Address - City:PELHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35124-3908
Mailing Address - Country:US
Mailing Address - Phone:205-835-2288
Mailing Address - Fax:
Practice Address - Street 1:130 STONEHAVEN DR
Practice Address - Street 2:
Practice Address - City:PELHAM
Practice Address - State:AL
Practice Address - Zip Code:35124-3908
Practice Address - Country:US
Practice Address - Phone:205-835-2288
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-27
Last Update Date:2023-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-131072363LF0000X
AL261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center