Healthcare Provider Details

I. General information

NPI: 1710950076
Provider Name (Legal Business Name): JOSH D PARKER FNP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/08/2006
Last Update Date: 04/13/2021
Certification Date: 04/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18780 INTERSTATE 20
CANTON TX
75103-3593
US

IV. Provider business mailing address

190 CIVIC CIR 235
LEWISVILLE TX
75067-3424
US

V. Phone/Fax

Practice location:
  • Phone: 903-567-7748
  • Fax:
Mailing address:
  • Phone: 972-219-9955
  • Fax: 972-219-9101

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number666659
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR01735-033
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: