MEDICARE: MRS. DETRICE L 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	3747P1801X	Personal Care Attendant	24-018102-1	IN
2	3747A0650X	Attendant Care Provider	24-018102-1	IN
3	376J00000X	Homemaker	24-018102-1	IN

General Provider Information

NPI Number	:	1740004654
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. DETRICE L PARKER

Provider Business Mailing Address
First Line	:	711 E 65TH ST STE 209
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46220-1609
Country	:	US
Telephone Number	:	317-728-0252
Fax Number	:	463-234-1617

Provider Business Practice Location Address
First Line	:	7164 GRAHAM RD STE 140
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46250-2675
Country	:	US
Telephone Number	:	317-728-0252
Fax Number	:	317-537-2107

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

Provider Enumeration Date	:	11/08/2024
Last Update Date	:	04/13/2026

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Directions to “ MRS. DETRICE L PARKER ” Practice Location

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