MEDICARE: DR. KINTA M PARKER PH.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	688	AL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1285714923
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KINTA M PARKER PH.D.

Provider Business Mailing Address
First Line	:	775 2ND ST
Second Line	:
City	:	HELENA
State	:	AL
Zip	:	35080-3209
Country	:	US
Telephone Number	:	205-664-9990
Fax Number	:	205-664-8882

Provider Business Practice Location Address
First Line	:	775 2ND ST
Second Line	:
City	:	HELENA
State	:	AL
Zip	:	35080-3209
Country	:	US
Telephone Number	:	205-664-9990
Fax Number	:	205-664-8882

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/17/2006
Last Update Date	:	08/01/2012

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