MEDICARE: KRISTY B. PARKER

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	103K00000X	Behavior Analyst	2011024910	MO

General Provider Information

NPI Number	:	1124300785
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTY B. PARKER

Provider Business Mailing Address
First Line	:	3230 WISCONSIN
Second Line	:
City	:	JOPLIN
State	:	MO
Zip	:	64804
Country	:	US
Telephone Number	:	417-347-7850
Fax Number	:

Provider Business Practice Location Address
First Line	:	25328 GUM RD
Second Line	:
City	:	CARL JUNCTION
State	:	MO
Zip	:	64834-8190
Country	:	US
Telephone Number	:	417-234-3455
Fax Number	:

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

Provider Enumeration Date	:	09/09/2011
Last Update Date	:	09/07/2023

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Directions to “ KRISTY B. PARKER ” Practice Location

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