Provider Demographics
NPI:1467286757
Name:PRIDGEN, ALEXIA ALYESE
Entity type:Individual
Prefix:
First Name:ALEXIA
Middle Name:ALYESE
Last Name:PRIDGEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3707 N MAIN ST STE D
Mailing Address - Street 2:
Mailing Address - City:FARMVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27828-1485
Mailing Address - Country:US
Mailing Address - Phone:919-583-2161
Mailing Address - Fax:
Practice Address - Street 1:3707 N MAIN ST STE D
Practice Address - Street 2:
Practice Address - City:FARMVILLE
Practice Address - State:NC
Practice Address - Zip Code:27828-1485
Practice Address - Country:US
Practice Address - Phone:919-583-2116
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-28
Last Update Date:2024-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385H00000XRespite Care FacilityRespite Care
No251E00000XAgenciesHome Health
No374U00000XNursing Service Related ProvidersHome Health Aide