MEDICARE: HENRY 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	3747P1801X	Personal Care Attendant		WV

General Provider Information

NPI Number	:	1992477350
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HENRY PARKER

Provider Business Mailing Address
First Line	:	612 VIRGINIA ST E
Second Line	:
City	:	CHARLESTON
State	:	WV
Zip	:	25301-2175
Country	:	US
Telephone Number	:	303-343-1130
Fax Number	:	304-343-8944

Provider Business Practice Location Address
First Line	:	1546 KANAWHA BLVD E APT 208
Second Line	:
City	:	CHARLESTON
State	:	WV
Zip	:	25311-2449
Country	:	US
Telephone Number	:	304-444-0822
Fax Number	:

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

Provider Enumeration Date	:	10/04/2021
Last Update Date	:	10/04/2021

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