Provider Demographics
NPI:1073574687
Name:PARKER, GREGORY (CFNP)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:
Last Name:PARKER
Suffix:
Gender:M
Credentials:CFNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 DARRAN ST
Mailing Address - Street 2:
Mailing Address - City:GULFPORT
Mailing Address - State:MS
Mailing Address - Zip Code:39503-3409
Mailing Address - Country:US
Mailing Address - Phone:228-831-1988
Mailing Address - Fax:228-832-3844
Practice Address - Street 1:130 DARRAN ST
Practice Address - Street 2:
Practice Address - City:GULFPORT
Practice Address - State:MS
Practice Address - Zip Code:39503-3409
Practice Address - Country:US
Practice Address - Phone:228-831-1988
Practice Address - Fax:228-832-3844
Is Sole Proprietor?:No
Enumeration Date:2006-03-31
Last Update Date:2014-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR764033363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS$$$$$$$$$AOtherBLUE CROSS
MS500000730Medicare ID - Type Unspecified
MS$$$$$$$$$AOtherBLUE CROSS