Provider Demographics
NPI:1154056588
Name:KAMPE, ALEXIS (RD, LD)
Entity Type:Individual
Prefix:
First Name:ALEXIS
Middle Name:
Last Name:KAMPE
Suffix:
Gender:F
Credentials:RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8301 HARCOURT RD STE 100
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46260-2082
Mailing Address - Country:US
Mailing Address - Phone:317-338-2051
Mailing Address - Fax:
Practice Address - Street 1:8301 HARCOURT RD
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46260-2081
Practice Address - Country:US
Practice Address - Phone:317-732-7071
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-20
Last Update Date:2022-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN37003179A133VN1301X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1301XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN86168057OtherCOMMISSION ON DIETETIC REGISTRATION