Healthcare Provider Details

I. General information

NPI: 1851335343
Provider Name (Legal Business Name): SCOTT ANDREW PARKER MS, ATC
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/15/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 UNIVERSITY PLZ MS 7000
CAPE GIRARDEAU MO
63701-4710
US

IV. Provider business mailing address

2061 PEAR TREE CT APT. #11
CAPE GIRARDEAU MO
63701-2111
US

V. Phone/Fax

Practice location:
  • Phone: 573-651-2451
  • Fax: 573-986-6156
Mailing address:
  • Phone: 573-270-3258
  • Fax: 573-986-6156

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number2005028046
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: