Healthcare Provider Details

I. General information

NPI: 1780537464
Provider Name (Legal Business Name): PARKER PSYCHIATRY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/20/2026
Last Update Date: 02/25/2026
Certification Date: 02/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

70 SW CENTURY DR STE 100 PMB 5030
BEND OR
97702-3558
US

IV. Provider business mailing address

70 SW CENTURY DR STE 100 PMB 5030
BEND OR
97702-3558
US

V. Phone/Fax

Practice location:
  • Phone: 541-241-6004
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MRS. MARYELLEN PARKER
Title or Position: OWNER
Credential: NP
Phone: 541-241-6004