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General NPI Number Information
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NPI Number | 1710360904
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Entity Type | Organization
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Legal Business Name | SPARKMAN NUTRITION
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Dates
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Enumeration Date | 07/07/2015
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Last Update Date | 07/07/2015
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Provider Practice Location Address
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Address Line | 4131 SPICEWOOD SPRINGS RD SUITE L-4
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City | AUSTIN
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State | TX
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Zip | 78759-8661
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Country | US
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Telephone | 512-257-0898
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Fax | 512-342-1043
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Provider Business Mailing Address
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Address Line | 4131 SPICEWOOD SPRINGS RD SUITE L-4
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City | AUSTIN
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State | TX
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Zip | 78759-8661
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Country | US
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Telephone | 512-257-0898
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Fax | 512-342-1043
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Authorized Official
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Title or Position | OWNER
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Name | MRS. ALEXA SPARKMAN
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Credential | MS, RD
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Telephone | 512-257-0898
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number | DT00782
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License Number State | TX
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