Healthcare Provider Details

I. General information

NPI: 1851839435
Provider Name (Legal Business Name): PARKER MEDICAL SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/03/2017
Last Update Date: 02/26/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1060 LISA LN
TERRY MS
39170-8092
US

IV. Provider business mailing address

1060 LISA LN
TERRY MS
39170-8092
US

V. Phone/Fax

Practice location:
  • Phone: 601-278-2698
  • Fax:
Mailing address:
  • Phone: 601-278-2698
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License NumberR865864
License Number StateMS

VIII. Authorized Official

Name: MRS. LISA PARKER
Title or Position: NURSE PRACTITIONER
Credential: NP-C
Phone: 601-278-2698