Provider Demographics
NPI:1083158802
Name:PARKER, PADGETT (PA-C)
Entity Type:Individual
Prefix:
First Name:PADGETT
Middle Name:
Last Name:PARKER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1850 HICKORY ST STE 200F
Mailing Address - Street 2:
Mailing Address - City:ABILENE
Mailing Address - State:TX
Mailing Address - Zip Code:79601-2305
Mailing Address - Country:US
Mailing Address - Phone:325-670-4590
Mailing Address - Fax:883-437-1277
Practice Address - Street 1:1850 HICKORY ST STE 200F
Practice Address - Street 2:
Practice Address - City:ABILENE
Practice Address - State:TX
Practice Address - Zip Code:79601-2305
Practice Address - Country:US
Practice Address - Phone:325-670-4590
Practice Address - Fax:883-437-1277
Is Sole Proprietor?:No
Enumeration Date:2016-12-13
Last Update Date:2022-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA10799363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX366673702Medicaid
TXP02601774OtherMCRR
TX1L4707OtherMEDICARE