MEDICARE: PARKER INTEGRATED MEDICAL AND WELLNESS, PLLC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	9480	OTHER	TX	STATE LICENSE

General Provider Information

NPI Number	:	1093472417
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PARKER INTEGRATED MEDICAL AND WELLNESS, PLLC.

Provider Business Mailing Address
First Line	:	4709 W PARKER RD STE 440
Second Line	:
City	:	PLANO
State	:	TX
Zip	:	75093-3369
Country	:	US
Telephone Number	:	972-212-5725
Fax Number	:

Provider Business Practice Location Address
First Line	:	4709 W PARKER RD STE 440
Second Line	:
City	:	PLANO
State	:	TX
Zip	:	75093-3369
Country	:	US
Telephone Number	:	972-212-5725
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	KARL A SHEPHERD
Credential	:	DC
Telephone Number	:	972-212-5725

Provider Enumeration Date	:	11/19/2021
Last Update Date	:	12/22/2021

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Directions to “PARKER INTEGRATED MEDICAL AND WELLNESS, PLLC. ” Practice Location

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