Provider Demographics
NPI:1376508218
Name:PARKER, SUSAN (CRNP)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:
Last Name:PARKER
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 518
Mailing Address - Street 2:18324 AL HWY 75
Mailing Address - City:HENAGAR
Mailing Address - State:AL
Mailing Address - Zip Code:35978-0518
Mailing Address - Country:US
Mailing Address - Phone:256-657-1101
Mailing Address - Fax:256-657-1115
Practice Address - Street 1:18324 ALABAMA HIGHWAY 75
Practice Address - Street 2:
Practice Address - City:HENAGAR
Practice Address - State:AL
Practice Address - Zip Code:35978
Practice Address - Country:US
Practice Address - Phone:256-657-1101
Practice Address - Fax:256-657-1115
Is Sole Proprietor?:No
Enumeration Date:2006-04-20
Last Update Date:2014-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1052657363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL051531253Medicare ID - Type Unspecified
ALS61404Medicare UPIN