Provider Demographics
NPI:1497192439
Name:PARKER, PEGGY ANN (APRN)
Entity Type:Individual
Prefix:
First Name:PEGGY
Middle Name:ANN
Last Name:PARKER
Suffix:
Gender:F
Credentials:APRN
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 398
Mailing Address - Street 2:301 DERBY STREET
Mailing Address - City:SUBLETTE
Mailing Address - State:KS
Mailing Address - Zip Code:67877-0398
Mailing Address - Country:US
Mailing Address - Phone:620-629-5937
Mailing Address - Fax:
Practice Address - Street 1:301 DERBY STREET
Practice Address - Street 2:
Practice Address - City:SUBLETTE
Practice Address - State:KS
Practice Address - Zip Code:67877-0398
Practice Address - Country:US
Practice Address - Phone:620-675-2686
Practice Address - Fax:620-675-2236
Is Sole Proprietor?:No
Enumeration Date:2013-05-31
Last Update Date:2021-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSTMP 146972363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner