Healthcare Provider Details

I. General information

NPI: 1831168855
Provider Name (Legal Business Name): PENNEY ELAINE PARKER FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/14/2006
Last Update Date: 08/23/2022
Certification Date: 08/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

653 BLUEFIELD RD STE A
MOORESVILLE NC
28117-9626
US

IV. Provider business mailing address

PO BOX 896199
CHARLOTTE NC
28289-6199
US

V. Phone/Fax

Practice location:
  • Phone: 704-360-6500
  • Fax: 980-444-2631
Mailing address:
  • Phone: 833-936-1364
  • Fax: 605-942-7505

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number201477
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: