Provider Demographics
NPI:1538618442
Name:SPARKS, LEZLIE LORRAINE (RDN, CDE)
Entity type:Individual
Prefix:
First Name:LEZLIE
Middle Name:LORRAINE
Last Name:SPARKS
Suffix:
Gender:F
Credentials:RDN, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:906 WEST MCDERMOTT
Mailing Address - Street 2:SUITE 116, PMB 272
Mailing Address - City:ALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:75013-5426
Mailing Address - Country:US
Mailing Address - Phone:469-835-5845
Mailing Address - Fax:
Practice Address - Street 1:4001 W 15TH ST STE 335
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093
Practice Address - Country:US
Practice Address - Phone:469-835-5845
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-03
Last Update Date:2018-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT01207133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered