Healthcare Provider Details

I. General information

NPI: 1225123771
Provider Name (Legal Business Name): MARY EMMALEE PARKES RD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: EMMY PARKES RD

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 01/12/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

UNIVERSITY OF MISSISSIPPI LENOIR HALL, ROOM 116 DEPARTMENT OF NUTRITION AND HOSPITALITY MANAGEMENT
UNIVERSITY MS
38677
US

IV. Provider business mailing address

UNIVERSITY OF MISSISSIPPI LENOIR HALL, ROOM 108 DEPARTMENT OF NUTRITION AND HOSPITALITY MANAGEMENT
UNIVERSITY MS
38677
US

V. Phone/Fax

Practice location:
  • Phone: 662-915-1830
  • Fax:
Mailing address:
  • Phone: 662-915-1830
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberD1096
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: