Provider Demographics
NPI:1134312937
Name:PARKER, DAPHANY MARICIA (ARNP, FNP-C)
Entity Type:Individual
Prefix:
First Name:DAPHANY
Middle Name:MARICIA
Last Name:PARKER
Suffix:
Gender:F
Credentials:ARNP, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21828 STICK ROSS MOUNTAIN RD
Mailing Address - Street 2:
Mailing Address - City:TAHLEQUAH
Mailing Address - State:OK
Mailing Address - Zip Code:74464-8065
Mailing Address - Country:US
Mailing Address - Phone:918-869-8670
Mailing Address - Fax:
Practice Address - Street 1:124 E MAIN ST
Practice Address - Street 2:
Practice Address - City:HULBERT
Practice Address - State:OK
Practice Address - Zip Code:74441-8902
Practice Address - Country:US
Practice Address - Phone:918-723-3997
Practice Address - Fax:918-723-3889
Is Sole Proprietor?:No
Enumeration Date:2007-08-24
Last Update Date:2013-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKR0068301363LF0000X
OK68301363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200120000AMedicaid