Healthcare Provider Details

I. General information

NPI: 1629840897
Provider Name (Legal Business Name): JACQUELINE PARAMORE PARKER FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/23/2023
Last Update Date: 04/20/2026
Certification Date: 04/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

167 LOCUST ST STE 204
SPRUCE PINE NC
28777-2702
US

IV. Provider business mailing address

1411 ENGLISH CT
WILMINGTON NC
28411-7059
US

V. Phone/Fax

Practice location:
  • Phone: 828-467-8815
  • Fax: 828-367-7827
Mailing address:
  • Phone: 910-279-0024
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number5019258
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: