Healthcare Provider Details

I. General information

NPI: 1982245106
Provider Name (Legal Business Name): JESSICA LYNN PARKER BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/30/2019
Last Update Date: 01/28/2025
Certification Date: 01/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6740 ROCK SPRING RD
WILMINGTON NC
28405-3185
US

IV. Provider business mailing address

112 ACADIAN LOOP APT 301
HAMPSTEAD NC
28443-0170
US

V. Phone/Fax

Practice location:
  • Phone: 910-619-6500
  • Fax:
Mailing address:
  • Phone: 910-833-2682
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-19-90221
License Number StateMO
# 3
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number2104
License Number StateNC
# 4
Primary TaxonomyN
Taxonomy Code2080P0006X
TaxonomyDevelopmental - Behavioral Pediatrics Physician
License Number0-23-14270
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: