Provider Demographics
NPI:1154961704
Name:WELLS, ALEXIS BIANCA (MPH, RD,LD)
Entity type:Individual
Prefix:
First Name:ALEXIS
Middle Name:BIANCA
Last Name:WELLS
Suffix:
Gender:F
Credentials:MPH, RD,LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14111 VANCE JACKSON RD APT 12107
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78249-2173
Mailing Address - Country:US
Mailing Address - Phone:956-455-3142
Mailing Address - Fax:
Practice Address - Street 1:14111 VANCE JACKSON RD APT 12107
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78249-2173
Practice Address - Country:US
Practice Address - Phone:956-455-3142
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-12
Last Update Date:2020-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX86119535133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty