Provider Demographics
NPI:1588407761
Name:STARKS, ALEXIS NICOLE
Entity type:Individual
Prefix:
First Name:ALEXIS
Middle Name:NICOLE
Last Name:STARKS
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 1:502 TURNER AVE
Mailing Address - Street 2:
Mailing Address - City:WHITE HALL
Mailing Address - State:AR
Mailing Address - Zip Code:71602-2846
Mailing Address - Country:US
Mailing Address - Phone:870-209-1397
Mailing Address - Fax:
Practice Address - Street 1:1400 CLAUD RD
Practice Address - Street 2:
Practice Address - City:WHITE HALL
Practice Address - State:AR
Practice Address - Zip Code:71602-8622
Practice Address - Country:US
Practice Address - Phone:870-247-9499
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-17
Last Update Date:2024-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR229296207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine