Healthcare Provider Details

I. General information

NPI: 1215551973
Provider Name (Legal Business Name): NICOLE LYNN PARKER RN, PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/28/2020
Last Update Date: 09/09/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 CHESTERFIELD CTR STE 457
CHESTERFIELD MO
63017-4834
US

IV. Provider business mailing address

400 CHESTERFIELD CTR STE 457
CHESTERFIELD MO
63017-4834
US

V. Phone/Fax

Practice location:
  • Phone: 314-948-4715
  • Fax: 314-579-3354
Mailing address:
  • Phone: 314-947-4715
  • Fax: 314-579-7439

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number2020015659
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: