Provider Demographics
NPI:1093323180
Name:PARKS, ALEXIS PARKS
Entity Type:Individual
Prefix:MS
First Name:ALEXIS
Middle Name:PARKS
Last Name:PARKS
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 1:973 5TH ST
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80302-7120
Mailing Address - Country:US
Mailing Address - Phone:303-443-3697
Mailing Address - Fax:
Practice Address - Street 1:973 5TH ST
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80302-7120
Practice Address - Country:US
Practice Address - Phone:303-443-3697
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-15
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education