Healthcare Provider Details

I. General information

NPI: 1972561009
Provider Name (Legal Business Name): VALENTINO ISAAC PARRIS FNP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/01/2006
Last Update Date: 10/16/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1585 3RD STREET BAYNE-JONES HOSPITAL,
FORT POLK LA
71459-5110
US

IV. Provider business mailing address

206 3RD ST
NEW LLANO LA
71461-9722
US

V. Phone/Fax

Practice location:
  • Phone: 337-531-3349
  • Fax:
Mailing address:
  • Phone: 760-267-4652
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number51419
License Number StateHI
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number62291
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: