Healthcare Provider Details

I. General information

NPI: 1265692891
Provider Name (Legal Business Name): MRS. TERESA KAY PARKER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/17/2008
Last Update Date: 06/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2650 N LAKELAND DR
COLUMBIA MO
65202-6972
US

IV. Provider business mailing address

2650 N LAKELAND DR
COLUMBIA MO
65202-6972
US

V. Phone/Fax

Practice location:
  • Phone: 573-814-0823
  • Fax: 573-814-2863
Mailing address:
  • Phone: 573-814-0823
  • Fax: 573-814-2863

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code177F00000X
TaxonomyLodging Provider
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: