Healthcare Provider Details

I. General information

NPI: 1215394747
Provider Name (Legal Business Name): JENNIFER ANNE PARKER R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/28/2016
Last Update Date: 01/28/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1061 HARMON AVE
FORT STEWART GA
31314-5641
US

IV. Provider business mailing address

524 HODGES RD
HINESVILLE GA
31313-6729
US

V. Phone/Fax

Practice location:
  • Phone: 859-457-9877
  • Fax:
Mailing address:
  • Phone: 859-457-9877
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WM0102X
TaxonomyMaternal Newborn Registered Nurse
License Number1131580
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: