Provider Demographics
NPI:1699196428
Name:MOTLEY, ALEXIS DARNELL (MS, RD, LDN)
Entity Type:Individual
Prefix:
First Name:ALEXIS
Middle Name:DARNELL
Last Name:MOTLEY
Suffix:
Gender:F
Credentials:MS, RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:148 DOUGLAS MEMORIAL RD
Mailing Address - Street 2:
Mailing Address - City:LEESVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:71446-5404
Mailing Address - Country:US
Mailing Address - Phone:318-485-9238
Mailing Address - Fax:
Practice Address - Street 1:1115 E 7TH AVE
Practice Address - Street 2:
Practice Address - City:OAKDALE
Practice Address - State:LA
Practice Address - Zip Code:71463-2301
Practice Address - Country:US
Practice Address - Phone:318-485-9238
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-20
Last Update Date:2019-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1106397133V00000X
1106397133NN1002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education