Provider Demographics
NPI:1457014169
Name:PARKER, LILLY DENNISE (RDN, LD)
Entity Type:Individual
Prefix:
First Name:LILLY
Middle Name:DENNISE
Last Name:PARKER
Suffix:
Gender:F
Credentials:RDN, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:106 E 6TH ST STE 900-183
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78701-3659
Mailing Address - Country:US
Mailing Address - Phone:512-975-9652
Mailing Address - Fax:
Practice Address - Street 1:106 E 6TH ST STE 900-183
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78701-3659
Practice Address - Country:US
Practice Address - Phone:512-975-9652
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-19
Last Update Date:2021-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT87346133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered