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NPI Code Detail

MEDICARE: KELLYN SHEPPARD PARKER

MEDICARE: KELLYN SHEPPARD 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
1363A00000XPhysician Assistant

General Provider Information

NPI Number : 1588590533
Entity Type Code : Individual
Provider Name (Legal Business Name) : KELLYN SHEPPARD PARKER
Provider Business Mailing Address
First Line : 2003 PERRY AVE
Second Line :
City : WILMINGTON
State : NC
Zip : 28403-1031
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 2131 S 17TH ST
Second Line :
City : WILMINGTON
State : NC
Zip : 28401-7407
Country : US
Telephone Number : 910-667-7000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/18/2026
Last Update Date : 06/18/2026

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Directions to “ KELLYN SHEPPARD PARKER ” Practice Location

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