MEDICARE: MRS. ANDREA MICHAELA PARKER

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number State
1	172V00000X	Community Health Worker	NV
2	251S00000X	Community/Behavioral Health Agency	NV
3	374U00000X	Home Health Aide	NV

General Provider Information

NPI Number	:	1093662306
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ANDREA MICHAELA PARKER

Provider Business Mailing Address
First Line	:	5912 SHAWNEE AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89107-2638
Country	:	US
Telephone Number	:	443-649-7823
Fax Number	:

Provider Business Practice Location Address
First Line	:	5912 SHAWNEE AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89107-2638
Country	:	US
Telephone Number	:	443-649-7823
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/16/2026
Last Update Date	:	04/08/2026

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