Provider Demographics
NPI:1164827242
Name:MCALLISTER, ALEXIS ANN (PNP)
Entity type:Individual
Prefix:MS
First Name:ALEXIS
Middle Name:ANN
Last Name:MCALLISTER
Suffix:
Gender:F
Credentials:PNP
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:9401 HOLY CROSS LN STE 112
Mailing Address - Street 2:
Mailing Address - City:BREESE
Mailing Address - State:IL
Mailing Address - Zip Code:62230-3510
Mailing Address - Country:US
Mailing Address - Phone:618-526-7271
Mailing Address - Fax:618-526-7313
Practice Address - Street 1:9401 HOLY CROSS LN STE 112
Practice Address - Street 2:
Practice Address - City:BREESE
Practice Address - State:IL
Practice Address - Zip Code:62230-3510
Practice Address - Country:US
Practice Address - Phone:618-526-7271
Practice Address - Fax:618-526-7313
Is Sole Proprietor?:No
Enumeration Date:2014-10-30
Last Update Date:2025-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209012323363L00000X, 363LP0200X
MO2018043672363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO420064410Medicaid