Healthcare Provider Details

I. General information

NPI: 1063597136
Provider Name (Legal Business Name): MARTI KRISTA DAVIS PARKINSON PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/26/2006
Last Update Date: 03/02/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

890 W ELLIOT RD SUITE 103
GILBERT AZ
85233-5102
US

IV. Provider business mailing address

1374 E BOSTON ST
CHANDLER AZ
85225-5420
US

V. Phone/Fax

Practice location:
  • Phone: 480-545-1413
  • Fax: 480-545-1434
Mailing address:
  • Phone: 309-453-7390
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number085-002850
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number4420
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: