Provider Demographics
NPI:1861892481
Name:PARKE, CHRIS (RD)
Entity type:Individual
Prefix:
First Name:CHRIS
Middle Name:
Last Name:PARKE
Suffix:
Gender:M
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1095 FOUR MILE RD
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:KY
Mailing Address - Zip Code:40475-9260
Mailing Address - Country:US
Mailing Address - Phone:859-582-9059
Mailing Address - Fax:
Practice Address - Street 1:200 BOONE WAY
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:KY
Practice Address - Zip Code:40475-9444
Practice Address - Country:US
Practice Address - Phone:859-582-9059
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-02
Last Update Date:2014-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY1533133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered