Healthcare Provider Details

I. General information

NPI: 1316944770
Provider Name (Legal Business Name): KATHLEEN ROSE PARKER RN, PNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2005
Last Update Date: 12/22/2022
Certification Date: 12/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1555 LONG POND RD
ROCHESTER NY
14626-4122
US

IV. Provider business mailing address

1555 LONG POND RD
ROCHESTER NY
14626-4122
US

V. Phone/Fax

Practice location:
  • Phone: 585-368-4012
  • Fax: 585-723-7470
Mailing address:
  • Phone: 585-368-4012
  • Fax: 585-723-7470

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number380878-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: