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General NPI Number Information
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NPI Number | 1154949246
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Entity Type | Individual
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Provider Name | KELLY JEAN PARKER APRN
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Gender | Female
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Dates
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Enumeration Date | 07/06/2020
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Last Update Date | 05/10/2023
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Provider Practice Location Address
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Address Line | 15630 SAUSALITO CIR
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City | CLERMONT
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State | FL
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Zip | 34711-9668
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Country | US
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Telephone | 352-242-6443
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Fax |
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Provider Business Mailing Address
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Address Line | 15630 SAUSALITO CIR
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City | CLERMONT
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State | FL
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Zip | 34711-9668
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Country | US
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Telephone | 352-242-6443
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LW0102X
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Taxonomy Name | Women's Health Nurse Practitioner
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License Number | APRN11011524
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | RN2740692
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License Number State | FL
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