Healthcare Provider Details

I. General information

NPI: 1912619347
Provider Name (Legal Business Name): LORETTA PARKER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/16/2022
Last Update Date: 08/06/2026
Certification Date: 08/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

316 CALHOUN ST
CHARLESTON SC
29401-1113
US

IV. Provider business mailing address

316 CALHOUN ST
CHARLESTON SC
29401-1113
US

V. Phone/Fax

Practice location:
  • Phone: 843-402-2273
  • Fax:
Mailing address:
  • Phone: 843-402-2273
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number6230
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: