Provider Demographics
NPI:1417363631
Name:PARKER, LILLIAN BAE (LAC)
Entity Type:Individual
Prefix:
First Name:LILLIAN
Middle Name:BAE
Last Name:PARKER
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:LILLIAN
Other - Middle Name:BAE
Other - Last Name:PARKER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:817 W WALNUT ST
Mailing Address - Street 2:SUITE 4A
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37604-6984
Mailing Address - Country:US
Mailing Address - Phone:423-302-0709
Mailing Address - Fax:
Practice Address - Street 1:817 W WALNUT ST
Practice Address - Street 2:SUITE 4A
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37604-6984
Practice Address - Country:US
Practice Address - Phone:423-302-0709
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-08
Last Update Date:2017-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN252171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist