Healthcare Provider Details

I. General information

NPI: 1346298973
Provider Name (Legal Business Name): LISA M.L. PARKER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/05/2006
Last Update Date: 02/27/2025
Certification Date: 02/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 KELLIE DR
SMITHFIELD NC
27577-9443
US

IV. Provider business mailing address

104 RHODES AVE
WINDSOR NC
27983-9656
US

V. Phone/Fax

Practice location:
  • Phone: 919-938-3749
  • Fax: 919-938-3749
Mailing address:
  • Phone: 252-794-3042
  • Fax: 252-794-2911

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number9901279
License Number StateNC

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier891223V
Identifier TypeMEDICAID
Identifier StateNC
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: