Healthcare Provider Details

I. General information

NPI: 1316580863
Provider Name (Legal Business Name): LOREE ANN PARKER FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/28/2019
Last Update Date: 05/11/2021
Certification Date: 05/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5133 RIVERS AVE
N CHARLESTON SC
29406-6338
US

IV. Provider business mailing address

PO BOX 751649
CHARLOTTE NC
28275-1649
US

V. Phone/Fax

Practice location:
  • Phone: 843-789-1786
  • Fax: 843-958-1263
Mailing address:
  • Phone: 843-789-1620
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number23364
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: