Healthcare Provider Details

I. General information

NPI: 1053019513
Provider Name (Legal Business Name): KALI PARKER RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/23/2023
Last Update Date: 02/23/2023
Certification Date: 02/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

298 TRICORN ROAD
DANVILLE WV
25053
US

IV. Provider business mailing address

6248 STRAIGHT FRK
HAMLIN WV
25523
US

V. Phone/Fax

Practice location:
  • Phone: 304-369-1385
  • Fax:
Mailing address:
  • Phone: 304-840-4114
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number115252
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: