Provider Demographics
NPI:1538834056
Name:RICCIONE, ALEXIS RYAN (CRNP)
Entity type:Individual
Prefix:
First Name:ALEXIS
Middle Name:RYAN
Last Name:RICCIONE
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 37643
Mailing Address - Street 2:
Mailing Address - City:BELFAST
Mailing Address - State:ME
Mailing Address - Zip Code:04915-1218
Mailing Address - Country:US
Mailing Address - Phone:843-682-7480
Mailing Address - Fax:
Practice Address - Street 1:40 OKATIE CENTER BLVD S STE 100
Practice Address - Street 2:
Practice Address - City:OKATIE
Practice Address - State:SC
Practice Address - Zip Code:29909-7519
Practice Address - Country:US
Practice Address - Phone:843-705-9145
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-16
Last Update Date:2025-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP024245363LF0000X
SC30208363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA103912787Medicaid
15171368OtherCAQH