Provider Demographics
NPI:1114942232
Name:PARKER, CHERYL (PA-C)
Entity Type:Individual
Prefix:
First Name:CHERYL
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 1:11550 STONE AVE N
Mailing Address - Street 2:204
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98133-1513
Mailing Address - Country:US
Mailing Address - Phone:206-985-8883
Mailing Address - Fax:
Practice Address - Street 1:CHILDREN'S HOSPITAL AND REGIONAL MEDICAL CENTER
Practice Address - Street 2:4800 SAND POINT WAY NE M/S W7706
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98105-3901
Practice Address - Country:US
Practice Address - Phone:206-987-1272
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA10004200363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8358491Medicaid
AKN/AMedicaid
MT4301391Medicaid
MT4301391Medicaid