Provider Demographics
NPI:1447732896
Name:INGLETON, ALEXIS ETIENNE
Entity type:Individual
Prefix:MS
First Name:ALEXIS
Middle Name:ETIENNE
Last Name:INGLETON
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 1:15840 BADGER CREEK LM
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76177
Mailing Address - Country:US
Mailing Address - Phone:817-901-2505
Mailing Address - Fax:
Practice Address - Street 1:15840 BADGER CREEK LM
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76177
Practice Address - Country:US
Practice Address - Phone:817-901-2505
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-02
Last Update Date:2018-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3104A0630XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Behavioral Disturbances
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX831181220OtherHEALING HANDS ASSISTED LIVING