Healthcare Provider Details

I. General information

NPI: 1265682025
Provider Name (Legal Business Name): NANCY M PARKER MA CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2008
Last Update Date: 08/13/2026
Certification Date: 08/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

410 NEW BRIDGE ST STE 10A
JACKSONVILLE NC
28540-4700
US

IV. Provider business mailing address

410 NEW BRIDGE ST STE 10A
JACKSONVILLE NC
28540-4700
US

V. Phone/Fax

Practice location:
  • Phone: 910-347-2212
  • Fax: 910-338-5013
Mailing address:
  • Phone: 910-347-2212
  • Fax: 910-338-5013

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number16138
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: