Healthcare Provider Details

I. General information

NPI: 1215384425
Provider Name (Legal Business Name): JOSHUA PARKER CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/17/2016
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1265 UNION AVE
MEMPHIS TN
38104-3415
US

IV. Provider business mailing address

5537 NEW POINTE DR
SOUTHAVEN MS
38672-7315
US

V. Phone/Fax

Practice location:
  • Phone: 901-725-5846
  • Fax:
Mailing address:
  • Phone: 901-299-2938
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number901452
License Number StateMS
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number21515
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: