Healthcare Provider Details

I. General information

NPI: 1730001397
Provider Name (Legal Business Name): PARKER SMITH PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2026
Last Update Date: 07/27/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2120 LIVE STRONGER ST
TEA SD
57064-8331
US

IV. Provider business mailing address

2120 LIVE STRONGER ST
TEA SD
57064-8331
US

V. Phone/Fax

Practice location:
  • Phone: 605-982-9545
  • Fax: 833-918-2049
Mailing address:
  • Phone: 605-982-9545
  • Fax: 833-918-2049

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberCP201342
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: