Provider Demographics
NPI:1528419777
Name:PARKER, JORDYN LEIGH
Entity Type:Individual
Prefix:MS
First Name:JORDYN
Middle Name:LEIGH
Last Name:PARKER
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:JORDYN
Other - Middle Name:LEIGH
Other - Last Name:PARKER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PA
Mailing Address - Street 1:1985 TATE BLVD SE
Mailing Address - Street 2:SUITE 600
Mailing Address - City:HICKORY
Mailing Address - State:NC
Mailing Address - Zip Code:28602-1498
Mailing Address - Country:US
Mailing Address - Phone:828-485-2510
Mailing Address - Fax:828-485-2517
Practice Address - Street 1:1985 TATE BLVD SE STE 600
Practice Address - Street 2:
Practice Address - City:HICKORY
Practice Address - State:NC
Practice Address - Zip Code:28602-1498
Practice Address - Country:US
Practice Address - Phone:828-485-2510
Practice Address - Fax:828-485-2517
Is Sole Proprietor?:No
Enumeration Date:2016-06-29
Last Update Date:2019-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-06544363AM0700X
363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical