Provider Demographics
NPI:1497221832
Name:PARKER, SEAN THOMAS (PA-C)
Entity Type:Individual
Prefix:MR
First Name:SEAN
Middle Name:THOMAS
Last Name:PARKER
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18990 COYOTE VALLEY RD STE 10
Mailing Address - Street 2:
Mailing Address - City:HIDDEN VALLEY LAKE
Mailing Address - State:CA
Mailing Address - Zip Code:95467-8339
Mailing Address - Country:US
Mailing Address - Phone:707-987-8344
Mailing Address - Fax:
Practice Address - Street 1:18990 COYOTE VALLEY RD STE 10
Practice Address - Street 2:
Practice Address - City:HIDDEN VALLEY LAKE
Practice Address - State:CA
Practice Address - Zip Code:95467-8339
Practice Address - Country:US
Practice Address - Phone:707-987-8344
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-23
Last Update Date:2019-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA56145363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant