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General NPI Number Information
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NPI Number | 1245712777
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Entity Type | Individual
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Provider Name | LESA PARKER MS, ARPN, NP-C
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Gender | Female
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Dates
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Enumeration Date | 08/31/2018
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Last Update Date | 04/24/2020
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Provider Practice Location Address
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Address Line | 772 MADDOX DR STE 122
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City | EAST ELLIJAY
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State | GA
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Zip | 30540-8196
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Country | US
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Telephone | 706-635-6898
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Fax |
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Provider Business Mailing Address
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Address Line | 165 BLUE RIDGE OVERLOOK
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City | BLUE RIDGE
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State | GA
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Zip | 30513-4431
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Country | US
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Telephone | 855-437-1557
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | RN184483
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License Number State | GA
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