Healthcare Provider Details

I. General information

NPI: 1609675651
Provider Name (Legal Business Name): ALEXIS LIVINGSTON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/12/2025
Last Update Date: 06/29/2026
Certification Date: 06/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4821 SAINT LEONARD RD
SAINT LEONARD MD
20685-2888
US

IV. Provider business mailing address

4705 ALLEN EARLIE RD
PRINCE FREDERICK MD
20678-3734
US

V. Phone/Fax

Practice location:
  • Phone: 301-980-4707
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133N00000X
TaxonomyNutritionist
License NumberDX8087
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: