Healthcare Provider Details

I. General information

NPI: 1801935051
Provider Name (Legal Business Name): ALEXA F SPARKMAN RD, LD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/05/2007
Last Update Date: 08/19/2010
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: 512-342-2931
Mailing address:
  • Phone: 512-257-0898
  • Fax: 512-342-2931

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: