Healthcare Provider Details

I. General information

NPI: 1639934698
Provider Name (Legal Business Name): JAMES LAVERNE PARKER ARNP, PMHNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/19/2024
Last Update Date: 04/08/2024
Certification Date: 03/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

855 A AVE NE STE 300
CEDAR RAPIDS IA
52402-5064
US

IV. Provider business mailing address

855 A AVE NE STE 300
CEDAR RAPIDS IA
52402-5064
US

V. Phone/Fax

Practice location:
  • Phone: 319-368-9301
  • Fax: 319-739-4380
Mailing address:
  • Phone: 319-368-9301
  • Fax: 319-739-4380

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberG178326
License Number StateIA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: