Provider Demographics
NPI:1679397731
Name:HAVLIK, ALEXIS (FNP-C)
Entity type:Individual
Prefix:
First Name:ALEXIS
Middle Name:
Last Name:HAVLIK
Suffix:
Gender:
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 1:25652 JAMES RIVER RD
Mailing Address - Street 2:
Mailing Address - City:MITCHELL
Mailing Address - State:SD
Mailing Address - Zip Code:57301-7504
Mailing Address - Country:US
Mailing Address - Phone:608-712-4684
Mailing Address - Fax:
Practice Address - Street 1:25652 JAMES RIVER RD
Practice Address - Street 2:
Practice Address - City:MITCHELL
Practice Address - State:SD
Practice Address - Zip Code:57301-7504
Practice Address - Country:US
Practice Address - Phone:608-712-4684
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-14
Last Update Date:2025-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDF11240044363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner