Provider Demographics
NPI:1033625199
Name:PARKER, KISSEY SMITH
Entity Type:Individual
Prefix:
First Name:KISSEY
Middle Name:SMITH
Last Name:PARKER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7021 MARTIN DR
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70126-2963
Mailing Address - Country:US
Mailing Address - Phone:504-457-9767
Mailing Address - Fax:
Practice Address - Street 1:3620 CLIO ST APT A
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70125-2343
Practice Address - Country:US
Practice Address - Phone:504-457-9767
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-26
Last Update Date:2023-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA006915060172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver