Provider Demographics
NPI:1316618309
Name:PILGRIM, ALEXIS J (APRN)
Entity type:Individual
Prefix:
First Name:ALEXIS
Middle Name:J
Last Name:PILGRIM
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:ALEXIS
Other - Middle Name:J
Other - Last Name:TIBBS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:PO BOX 1960
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72403-1960
Mailing Address - Country:US
Mailing Address - Phone:870-936-7000
Mailing Address - Fax:870-934-3677
Practice Address - Street 1:4808 E JOHNSON AVE
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:AR
Practice Address - Zip Code:72405-8413
Practice Address - Country:US
Practice Address - Phone:870-936-7000
Practice Address - Fax:870-934-3677
Is Sole Proprietor?:No
Enumeration Date:2021-09-21
Last Update Date:2024-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR216452363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily