Healthcare Provider Details

I. General information

NPI: 1720902372
Provider Name (Legal Business Name): KIMBERLY KAY PARKER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/06/2026
Last Update Date: 08/06/2026
Certification Date: 08/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4817 IOWA AVE NW
WASHINGTON DC
20011-4435
US

IV. Provider business mailing address

8787 BRANCH AVE # 146
CLINTON MD
20735-2630
US

V. Phone/Fax

Practice location:
  • Phone: 240-543-2589
  • Fax:
Mailing address:
  • Phone: 240-543-2589
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: