Healthcare Provider Details

I. General information

NPI: 1013369024
Provider Name (Legal Business Name): PARKER SURGICAL PARTNERS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/01/2016
Last Update Date: 07/01/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

717 W PARK DR
KELLER TX
76248-2511
US

IV. Provider business mailing address

717 W PARK DR
KELLER TX
76248-2511
US

V. Phone/Fax

Practice location:
  • Phone: 817-562-8577
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberAP130426
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code246ZC0007X
TaxonomySurgical Assistant
License NumberSA00501
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code163WR0006X
TaxonomyRegistered Nurse First Assistant
License Number808428
License Number StateTX

VIII. Authorized Official

Name: ANTAY PARKER
Title or Position: OWNER/PROVIDER
Credential: WHNP-BC, RNFA
Phone: 817-562-8577