Healthcare Provider Details

I. General information

NPI: 1720584501
Provider Name (Legal Business Name): PARKER HURLEY
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: PATRICIA PARKER

II. Dates (important events)

Enumeration Date: 04/02/2018
Last Update Date: 04/02/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1415 W NC HIGHWAY 54 STE 121
DURHAM NC
27707-5578
US

IV. Provider business mailing address

1502 W NC HIGHWAY 54 STE 103
DURHAM NC
27707-5572
US

V. Phone/Fax

Practice location:
  • Phone: 919-401-2933
  • Fax: 919-401-2994
Mailing address:
  • Phone: 919-354-0840
  • Fax: 919-748-4441

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberP009503
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: