Provider Demographics
NPI:1588281018
Name:PARKS, ANNIE LAINE (RD)
Entity type:Individual
Prefix:
First Name:ANNIE
Middle Name:LAINE
Last Name:PARKS
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:805 N TRINITY ST
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:TX
Mailing Address - Zip Code:76234-1146
Mailing Address - Country:US
Mailing Address - Phone:940-389-8708
Mailing Address - Fax:
Practice Address - Street 1:805 N TRINITY ST
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:TX
Practice Address - Zip Code:76234-1146
Practice Address - Country:US
Practice Address - Phone:940-389-8708
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-30
Last Update Date:2020-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered