MEDICARE: KIMBERLEY M. PARKER FNP

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	390200000X	Student in an Organized Health Care Education/Training Program		CA
2	363LF0000X	Family Nurse Practitioner	95017911	CA

General Provider Information

NPI Number	:	1649849779
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIMBERLEY M. PARKER FNP

Provider Business Mailing Address
First Line	:	7911 SEAWALL CIR
Second Line	:
City	:	HUNTINGTON BEACH
State	:	CA
Zip	:	92648-5464
Country	:	US
Telephone Number	:	541-680-7475
Fax Number	:

Provider Business Practice Location Address
First Line	:	7911 SEAWALL CIR
Second Line	:
City	:	HUNTINGTON BEACH
State	:	CA
Zip	:	92648-5464
Country	:	US
Telephone Number	:	541-680-7475
Fax Number	:

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

Provider Enumeration Date	:	06/22/2021
Last Update Date	:	08/10/2021

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