Healthcare Provider Details

I. General information

NPI: 1073703211
Provider Name (Legal Business Name): GLENDA POWELL PARKER FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/25/2007
Last Update Date: 11/23/2021
Certification Date: 11/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4300 N.C. HWY 49
HARRISBURG NC
28075
US

IV. Provider business mailing address

4300 N.C. HWY 49
HARRISBURG NC
28075
US

V. Phone/Fax

Practice location:
  • Phone: 704-455-6420
  • Fax: 704-454-5124
Mailing address:
  • Phone: 704-455-6420
  • Fax: 704-454-5124

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number18295
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code364SF0001X
TaxonomyFamily Health Clinical Nurse Specialist
License Number070835
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code364SF0001X
TaxonomyFamily Health Clinical Nurse Specialist
License Number5003233
License Number StateNC
# 4
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number5003233
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: