=====================================================
General NPI Number Information
=====================================================
NPI Number | 1952117681
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | NANCY PARKER
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/07/2024
-----------------------------------------------------
Last Update Date | 12/07/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2601 SPENCER RD
-----------------------------------------------------
City | SPENCER
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 73084-3649
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 405-427-2441
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2400 WATERMARK BLVD APT 1321
-----------------------------------------------------
City | OKLAHOMA CITY
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 73134-5609
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 469-268-2227
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 163WP0808X
-----------------------------------------------------
Taxonomy Name | Psychiatric/Mental Health Registered Nurse
-----------------------------------------------------
License Number | 984213
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------