Provider Demographics
NPI:1386016954
Name:PARKER, JICKIE (ARNP)
Entity Type:Individual
Prefix:
First Name:JICKIE
Middle Name:
Last Name:PARKER
Suffix:
Gender:F
Credentials:ARNP
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 2546
Mailing Address - Street 2:
Mailing Address - City:JOPLIN
Mailing Address - State:MO
Mailing Address - Zip Code:64803-2546
Mailing Address - Country:US
Mailing Address - Phone:620-783-4441
Mailing Address - Fax:620-783-4090
Practice Address - Street 1:444 FOUR STATES DR.
Practice Address - Street 2:STE 1
Practice Address - City:GALENA
Practice Address - State:KS
Practice Address - Zip Code:66739-4325
Practice Address - Country:US
Practice Address - Phone:620-783-4441
Practice Address - Fax:620-783-4090
Is Sole Proprietor?:No
Enumeration Date:2015-10-22
Last Update Date:2015-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2014042976363L00000X
KSTMP-999999363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner