Provider Demographics
NPI:1932739315
Name:PARKS, ALEXIS LANIER (PA)
Entity Type:Individual
Prefix:
First Name:ALEXIS
Middle Name:LANIER
Last Name:PARKS
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:ALEXIS
Other - Middle Name:CAROLINE
Other - Last Name:LANIER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:380 CALVERT RD
Mailing Address - Street 2:
Mailing Address - City:SALISBURY
Mailing Address - State:NC
Mailing Address - Zip Code:28146-5058
Mailing Address - Country:US
Mailing Address - Phone:336-772-4018
Mailing Address - Fax:
Practice Address - Street 1:380 CALVERT RD
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:NC
Practice Address - Zip Code:28146-5058
Practice Address - Country:US
Practice Address - Phone:336-772-4018
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-24
Last Update Date:2021-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program