Provider Demographics
NPI:1497739775
Name:PARKER, MITCHELL (FNP)
Entity Type:Individual
Prefix:
First Name:MITCHELL
Middle Name:
Last Name:PARKER
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:202 WILLIAMSON RD STE 100
Mailing Address - Street 2:
Mailing Address - City:MOORESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28117-7610
Mailing Address - Country:US
Mailing Address - Phone:704-799-7811
Mailing Address - Fax:704-799-7812
Practice Address - Street 1:202 WILLIAMSON RD STE 100
Practice Address - Street 2:
Practice Address - City:MOORESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28117-7610
Practice Address - Country:US
Practice Address - Phone:704-799-7811
Practice Address - Fax:704-799-7812
Is Sole Proprietor?:No
Enumeration Date:2005-12-01
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARN652600163W00000X
CANP15520363LF0000X
NC258970363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
CARN652600OtherRN LIC #
CAF0898079OtherAANP CERT #
CAMB1298226OtherDEA CERT #
CAP56037Medicare UPIN
CAF0898079OtherAANP CERT #