MEDICARE: KELLY M PARKER 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	26NJ15495400	NJ

General Provider Information

NPI Number	:	1780267153
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELLY M PARKER FNP-BC

Provider Business Mailing Address
First Line	:	6 PLEASANT VILLAGE DR
Second Line	:
City	:	SUCCASUNNA
State	:	NJ
Zip	:	07876-1144
Country	:	US
Telephone Number	:	862-812-6412
Fax Number	:

Provider Business Practice Location Address
First Line	:	89 SPARTA AVE STE 200
Second Line	:
City	:	SPARTA
State	:	NJ
Zip	:	07871-1790
Country	:	US
Telephone Number	:	973-726-7220
Fax Number	:

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

Provider Enumeration Date	:	05/03/2021
Last Update Date	:	03/13/2026

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