Healthcare Provider Details

I. General information

NPI: 1710360904
Provider Name (Legal Business Name): SPARKMAN NUTRITION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/07/2015
Last Update Date: 07/07/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4131 SPICEWOOD SPRINGS RD SUITE L-4
AUSTIN TX
78759-8661
US

IV. Provider business mailing address

4131 SPICEWOOD SPRINGS RD SUITE L-4
AUSTIN TX
78759-8661
US

V. Phone/Fax

Practice location:
  • Phone: 512-257-0898
  • Fax: 512-342-1043
Mailing address:
  • Phone: 512-257-0898
  • Fax: 512-342-1043

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberDT00782
License Number StateTX

VIII. Authorized Official

Name: MRS. ALEXA SPARKMAN
Title or Position: OWNER
Credential: MS, RD
Phone: 512-257-0898