Provider Demographics
NPI:1730934290
Name:ALEXIS, KATHUSCIA BEAUVAIS (FNP)
Entity type:Individual
Prefix:
First Name:KATHUSCIA
Middle Name:BEAUVAIS
Last Name:ALEXIS
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:KATHUSCIA
Other - Middle Name:
Other - Last Name:BEAUVAIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:391 RANDALL AVE
Mailing Address - Street 2:
Mailing Address - City:ELMONT
Mailing Address - State:NY
Mailing Address - Zip Code:11003-3108
Mailing Address - Country:US
Mailing Address - Phone:347-358-4152
Mailing Address - Fax:
Practice Address - Street 1:391 RANDALL AVE
Practice Address - Street 2:
Practice Address - City:ELMONT
Practice Address - State:NY
Practice Address - Zip Code:11003-3108
Practice Address - Country:US
Practice Address - Phone:347-358-4152
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-18
Last Update Date:2024-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF353968-01363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily