Provider Demographics
NPI:1922787662
Name:PARKER, CAITLIN BRIANNA (MS, RD)
Entity Type:Individual
Prefix:
First Name:CAITLIN
Middle Name:BRIANNA
Last Name:PARKER
Suffix:
Gender:F
Credentials:MS, RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:332 MALI HEIGHTS CT
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89074-1289
Mailing Address - Country:US
Mailing Address - Phone:479-402-5009
Mailing Address - Fax:
Practice Address - Street 1:332 MALI HEIGHTS CT
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89074-1289
Practice Address - Country:US
Practice Address - Phone:479-402-5009
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-11
Last Update Date:2023-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL86054920133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
No133V00000XDietary & Nutritional Service ProvidersDietitian, Registered