Provider Demographics
NPI:1427366749
Name:PARKER, VANESSA C (PHD,RN,PHN,PMHNP-BC)
Entity Type:Individual
Prefix:DR
First Name:VANESSA
Middle Name:C
Last Name:PARKER
Suffix:
Gender:F
Credentials:PHD,RN,PHN,PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1510 W SUNSET RD STE 110
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89014-2695
Mailing Address - Country:US
Mailing Address - Phone:888-375-8698
Mailing Address - Fax:702-342-8108
Practice Address - Street 1:1510 W SUNSET RD STE 110
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89014-2695
Practice Address - Country:US
Practice Address - Phone:888-375-8698
Practice Address - Fax:702-342-8108
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-21
Last Update Date:2021-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVAPRN002728363LP0808X
CA20809363LP0808X, 2083P0901X
CA754202163W00000X
AZRN189053163W00000X
NVRN96160163W00000X
174H00000X, 261QM0801X
AZAP7493363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse
No174H00000XOther Service ProvidersHealth Educator
No2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive Medicine
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1235795824Medicaid