MEDICARE: ANDRAQ PARKER

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	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1518491414
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANDRAQ PARKER

Provider Business Mailing Address
First Line	:	7705 WEST PARKWAY BLVD 104
Second Line	:
City	:	TULSA
State	:	OK
Zip	:	74106
Country	:	US
Telephone Number	:	918-904-9564
Fax Number	:

Provider Business Practice Location Address
First Line	:	7705 W PARKWAY BLVD APT 104
Second Line	:
City	:	TULSA
State	:	OK
Zip	:	74127-5536
Country	:	US
Telephone Number	:	918-904-9564
Fax Number	:

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

Provider Enumeration Date	:	04/18/2017
Last Update Date	:	04/18/2017

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Directions to “ ANDRAQ PARKER ” Practice Location

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