Provider Demographics
NPI:1205034899
Name:PARKER, ARLENE FAE (C PED)
Entity Type:Individual
Prefix:MRS
First Name:ARLENE
Middle Name:FAE
Last Name:PARKER
Suffix:
Gender:F
Credentials:C PED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:341 W CHESTNUT
Mailing Address - Street 2:
Mailing Address - City:NOBLE
Mailing Address - State:OK
Mailing Address - Zip Code:73068-8545
Mailing Address - Country:US
Mailing Address - Phone:405-872-7117
Mailing Address - Fax:405-872-1653
Practice Address - Street 1:341 W CHESTNUT
Practice Address - Street 2:
Practice Address - City:NOBLE
Practice Address - State:OK
Practice Address - Zip Code:73068-8545
Practice Address - Country:US
Practice Address - Phone:405-872-7117
Practice Address - Fax:405-872-1653
Is Sole Proprietor?:No
Enumeration Date:2007-07-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK33174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK1245238559OtherORGANIZATION PROVIDER NPI
OK1250270001Medicare ID - Type Unspecified