MEDICARE: MR. VALENTINO ISAAC PARRIS 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	163W00000X	Registered Nurse	51419	HI
2	363LF0000X	Family Nurse Practitioner	62291	HI

General Provider Information

NPI Number	:	1972561009
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. VALENTINO ISAAC PARRIS FNP

Provider Business Mailing Address
First Line	:	206 3RD ST
Second Line	:
City	:	NEW LLANO
State	:	LA
Zip	:	71461-9722
Country	:	US
Telephone Number	:	760-267-4652
Fax Number	:

Provider Business Practice Location Address
First Line	:	1585 3RD STREET
Second Line	:	BAYNE-JONES HOSPITAL,
City	:	FORT POLK
State	:	LA
Zip	:	71459-5110
Country	:	US
Telephone Number	:	337-531-3349
Fax Number	:

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

Provider Enumeration Date	:	05/01/2006
Last Update Date	:	10/16/2013

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