Provider Demographics
NPI:1447933064
Name:CONNER, ALEXIS ELIZABETH (RDN, LDN, MHS)
Entity type:Individual
Prefix:
First Name:ALEXIS
Middle Name:ELIZABETH
Last Name:CONNER
Suffix:
Gender:F
Credentials:RDN, LDN, MHS
Other - Prefix:
Other - First Name:ALEXIS
Other - Middle Name:ELIZABETH
Other - Last Name:CONNER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RDN, LDN, MHS
Mailing Address - Street 1:165 PHILADELPHIA CHURCH RD
Mailing Address - Street 2:
Mailing Address - City:ELLENBORO
Mailing Address - State:NC
Mailing Address - Zip Code:28040-6797
Mailing Address - Country:US
Mailing Address - Phone:828-748-2988
Mailing Address - Fax:
Practice Address - Street 1:640 SUMMIT CROSSING PL STE 205
Practice Address - Street 2:
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28054-2183
Practice Address - Country:US
Practice Address - Phone:704-671-7850
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-10
Last Update Date:2023-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCL007473133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered