Healthcare Provider Details

I. General information

NPI: 1588596654
Provider Name (Legal Business Name): BREANNA PARKER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/02/2026
Last Update Date: 06/02/2026
Certification Date: 06/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

372 WEST ST STE 102
KEENE NH
03431-2412
US

IV. Provider business mailing address

5 ISNER CT
MOUNDSVILLE WV
26041-1212
US

V. Phone/Fax

Practice location:
  • Phone: 866-534-2639
  • Fax: 800-480-7578
Mailing address:
  • Phone: 304-639-5974
  • Fax: 800-480-7578

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: