Provider Demographics
NPI:1760206577
Name:POOLE, ALEXIS (RD)
Entity type:Individual
Prefix:
First Name:ALEXIS
Middle Name:
Last Name:POOLE
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 1:69 WOODLORE CIR
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72211-2379
Mailing Address - Country:US
Mailing Address - Phone:501-593-9580
Mailing Address - Fax:
Practice Address - Street 1:650 UNITED DR STE 100
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:AR
Practice Address - Zip Code:72032-7000
Practice Address - Country:US
Practice Address - Phone:501-504-6270
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-09
Last Update Date:2024-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR1918133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered