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NPI Code Detail

MEDICARE: MRS. KATHLEEN ROSE PARKER RN, PNP-BC

MEDICARE: MRS. KATHLEEN ROSE PARKER RN, PNP-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
1363LP0200XPediatric Nurse Practitioner380878-1NY

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
19512159OTHERIHA
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3000560245002OTHERCOMM BLUE
4NP0052OTHERPREF CARE

General Provider Information

NPI Number : 1316944770
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. KATHLEEN ROSE PARKER RN, PNP-BC
Provider Business Mailing Address
First Line : 1555 LONG POND RD
Second Line :
City : ROCHESTER
State : NY
Zip : 14626-4122
Country : US
Telephone Number : 585-368-4012
Fax Number : 585-723-7470
Provider Business Practice Location Address
First Line : 1555 LONG POND RD
Second Line :
City : ROCHESTER
State : NY
Zip : 14626-4122
Country : US
Telephone Number : 585-368-4012
Fax Number : 585-723-7470
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/30/2005
Last Update Date : 12/22/2022

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