Provider Demographics
NPI:1093073025
Name:PARKER, KENDA J (NP-C)
Entity Type:Individual
Prefix:
First Name:KENDA
Middle Name:J
Last Name:PARKER
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 E WARWICK DR
Mailing Address - Street 2:
Mailing Address - City:ALMA
Mailing Address - State:MI
Mailing Address - Zip Code:48801-1012
Mailing Address - Country:US
Mailing Address - Phone:855-289-5353
Mailing Address - Fax:989-633-0349
Practice Address - Street 1:200 E WARWICK DR
Practice Address - Street 2:
Practice Address - City:ALMA
Practice Address - State:MI
Practice Address - Zip Code:48801-1012
Practice Address - Country:US
Practice Address - Phone:855-289-5353
Practice Address - Fax:989-633-0349
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-27
Last Update Date:2012-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704175268363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner