Healthcare Provider Details

I. General information

NPI: 1588501878
Provider Name (Legal Business Name): PARKER SCOUT GORE OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2026
Last Update Date: 05/04/2026
Certification Date: 05/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

109 BEE ST
CHARLESTON SC
29401-5703
US

IV. Provider business mailing address

162 CALAIS DR
MAUMELLE AR
72113-7201
US

V. Phone/Fax

Practice location:
  • Phone: 501-940-5484
  • Fax:
Mailing address:
  • Phone: 501-940-5484
  • 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 StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: