Healthcare Provider Details

I. General information

NPI: 1407980568
Provider Name (Legal Business Name): MARY KATHRYN PARHAM FNP, PMHNP, APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/14/2007
Last Update Date: 07/04/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 N WEST SHORE BLVD STE 240
TAMPA FL
33607-4629
US

IV. Provider business mailing address

140 ISLAND WAY UNIT 127
CLEARWATER BEACH FL
33767-2216
US

V. Phone/Fax

Practice location:
  • Phone: 813-636-8300
  • Fax: 813-636-8301
Mailing address:
  • Phone: 305-447-2828
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily
License NumberAPRN9214558
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health
License NumberAPRN9214558
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: