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General NPI Number Information
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NPI Number | 1548770175
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Entity Type | Individual
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Provider Name | GREGORY K PARKER AGPCNP
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Gender | Male
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Dates
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Enumeration Date | 10/10/2017
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Last Update Date | 07/24/2020
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Provider Practice Location Address
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Address Line | 101 S 5TH ST STE 2500
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City | LOUISVILLE
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State | KY
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Zip | 40202-3066
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Country | US
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Telephone | 574-546-1900
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Fax | 574-546-1999
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Provider Business Mailing Address
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Address Line | PO BOX 10299
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City | FORT WAYNE
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State | IN
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Zip | 46851-0299
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Country | US
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Telephone | 574-546-1900
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Fax | 574-546-1999
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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 | 363LG0600X
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Taxonomy Name | Gerontology Nurse Practitioner
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License Number | 71010192A
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 363LG0600X
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Taxonomy Name | Gerontology Nurse Practitioner
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License Number | 3011789
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License Number State | KY
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