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NPI Code Detail

MEDICARE: MARYA JANELLE PARKER NP

MEDICARE:   MARYA JANELLE PARKER  NP
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
1163WM0705XMedical-Surgical Registered Nurse20672SC
2363LP2300XPrimary Care Nurse Practitioner201910419NP-PPOR

General Provider Information

NPI Number : 1114452463
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARYA JANELLE PARKER NP
Provider Business Mailing Address
First Line : 3006 KNIGHTBRIDGE RD
Second Line :
City : COLUMBIA
State : SC
Zip : 29223-2131
Country : US
Telephone Number : 803-736-8142
Fax Number :
Provider Business Practice Location Address
First Line : 3006 KNIGHTBRIDGE RD
Second Line :
City : COLUMBIA
State : SC
Zip : 29223-2131
Country : US
Telephone Number : 803-736-8142
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/25/2017
Last Update Date : 11/04/2020

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