Provider Demographics
NPI:1225123771
Name:PARKES, MARY EMMALEE (RD)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:EMMALEE
Last Name:PARKES
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:EMMY
Other - Middle Name:
Other - Last Name:PARKES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RD
Mailing Address - Street 1:UNIVERSITY OF MISSISSIPPI LENOIR HALL, ROOM 108
Mailing Address - Street 2:DEPARTMENT OF NUTRITION AND HOSPITALITY MANAGEMENT
Mailing Address - City:UNIVERSITY
Mailing Address - State:MS
Mailing Address - Zip Code:38677
Mailing Address - Country:US
Mailing Address - Phone:662-915-1830
Mailing Address - Fax:
Practice Address - Street 1:UNIVERSITY OF MISSISSIPPI LENOIR HALL, ROOM 116
Practice Address - Street 2:DEPARTMENT OF NUTRITION AND HOSPITALITY MANAGEMENT
Practice Address - City:UNIVERSITY
Practice Address - State:MS
Practice Address - Zip Code:38677
Practice Address - Country:US
Practice Address - Phone:662-915-1830
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2012-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSD1096133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS512I710003Medicare PIN
MSQ04953Medicare UPIN
MS710000114Medicare PIN