Provider Demographics
NPI:1275762874
Name:PARKER, JEREMY ALLEN (PA-C)
Entity Type:Individual
Prefix:MR
First Name:JEREMY
Middle Name:ALLEN
Last Name:PARKER
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:1892 W US HWY 290
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:TX
Mailing Address - Zip Code:78624-6644
Mailing Address - Country:US
Mailing Address - Phone:830-304-1666
Mailing Address - Fax:830-304-1665
Practice Address - Street 1:1892 W US HWY 290
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:TX
Practice Address - Zip Code:78624-6644
Practice Address - Country:US
Practice Address - Phone:830-304-1666
Practice Address - Fax:830-304-1665
Is Sole Proprietor?:No
Enumeration Date:2009-07-06
Last Update Date:2022-03-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXPA06383363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical