Provider Demographics
NPI:1073582631
Name:CORBIN, ALEXIS (RD)
Entity Type:Individual
Prefix:
First Name:ALEXIS
Middle Name:
Last Name:CORBIN
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 W 3RD ST
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74103-3421
Mailing Address - Country:US
Mailing Address - Phone:918-585-3045
Mailing Address - Fax:918-585-3047
Practice Address - Street 1:115 W 3RD ST
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74103-3410
Practice Address - Country:US
Practice Address - Phone:918-585-3045
Practice Address - Fax:918-585-3047
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1393133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered