Provider Demographics
NPI:1346909405
Name:PACKER, PARISH L
Entity Type:Individual
Prefix:
First Name:PARISH
Middle Name:L
Last Name:PACKER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:PARISH
Other - Middle Name:L
Other - Last Name:PACKER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:2565 VAN PATTEN ST APT 6
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89109-1350
Mailing Address - Country:US
Mailing Address - Phone:872-212-8813
Mailing Address - Fax:
Practice Address - Street 1:2565 VAN PATTEN ST APT 6
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89109-1350
Practice Address - Country:US
Practice Address - Phone:872-212-8813
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-15
Last Update Date:2021-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV0250Medicaid