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NPI Code Detail

MEDICARE: CASSANDRA SHIVAR PARKER FNP-BC

MEDICARE: CASSANDRA SHIVAR 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
1363LF0000XFamily Nurse Practitioner212045SC
2363L00000XNurse PractitionerRN224536GA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1962190090
Entity Type Code : Individual
Provider Name (Legal Business Name) : CASSANDRA SHIVAR PARKER FNP-BC
Provider Business Mailing Address
First Line : 10 BIG OAK ST
Second Line :
City : HILTON HEAD ISLAND
State : SC
Zip : 29926-1140
Country : US
Telephone Number : 843-460-0962
Fax Number : 929-299-4428
Provider Business Practice Location Address
First Line : 220 N MAIN ST STE 500
Second Line :
City : GREENVILLE
State : SC
Zip : 29601-2129
Country : US
Telephone Number : 929-299-4428
Fax Number : 929-299-4428
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/26/2023
Last Update Date : 05/05/2025

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Directions to “ CASSANDRA SHIVAR PARKER FNP-BC” Practice Location

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