Healthcare Provider Details

I. General information

NPI: 1740877950
Provider Name (Legal Business Name): SPENSER F PARKER PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/22/2020
Last Update Date: 03/23/2023
Certification Date: 03/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10561 JEFFREYS ST
HENDERSON NV
89052-4266
US

IV. Provider business mailing address

1236 LA BALLENA TRL
HENDERSON NV
89074-8100
US

V. Phone/Fax

Practice location:
  • Phone: 702-565-6565
  • Fax: 702-932-9001
Mailing address:
  • Phone: 281-639-0004
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA2383
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberPA2383
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: