Provider Demographics
NPI:1396445045
Name:PARKER, ALEXIS SHAUNTAY
Entity type:Individual
Prefix:
First Name:ALEXIS
Middle Name:SHAUNTAY
Last Name:PARKER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1237 GARDEN VILLAGE DR
Mailing Address - Street 2:
Mailing Address - City:FLORISSANT
Mailing Address - State:MO
Mailing Address - Zip Code:63031-1962
Mailing Address - Country:US
Mailing Address - Phone:314-749-9117
Mailing Address - Fax:314-942-1597
Practice Address - Street 1:8790 MANCHESTER RD STE 205C
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:MO
Practice Address - Zip Code:63144-2731
Practice Address - Country:US
Practice Address - Phone:314-266-8607
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-09
Last Update Date:2023-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide