Healthcare Provider Details

I. General information

NPI: 1417103953
Provider Name (Legal Business Name): KRISTINE I PARKER MBBS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/15/2008
Last Update Date: 08/30/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

96 JONATHAN LUCAS STREET SUITE 816
CHARLESTON SC
29425-6240
US

IV. Provider business mailing address

96 JONATHAN LUCAS STREET SUITE 816
CHARLESTON SC
29425-6240
US

V. Phone/Fax

Practice location:
  • Phone: 843-792-2529
  • Fax: 843-792-2529
Mailing address:
  • Phone: 843-792-2529
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: