MEDICARE: KIZZY MYISHA PARKER PMHNP-BC, FNP-BC

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	AP133624	TX
2	163WE0003X	Emergency Registered Nurse	849560	TX
3	363L00000X	Nurse Practitioner	95006709	CA

General Provider Information

NPI Number	:	1144775719
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIZZY MYISHA PARKER PMHNP-BC, FNP-BC

Provider Business Mailing Address
First Line	:	5517 CABRILLO WAY
Second Line	:
City	:	ROCKLIN
State	:	CA
Zip	:	95765-5148
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	785 ORCHARD DR STE 250
Second Line	:
City	:	FOLSOM
State	:	CA
Zip	:	95630-5547
Country	:	US
Telephone Number	:	916-258-2199
Fax Number	:

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

Provider Enumeration Date	:	08/24/2016
Last Update Date	:	12/02/2025

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