Provider Demographics
NPI:1558796359
Name:PARKER, JENNIFER LEE-ANN (CNM)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:LEE-ANN
Last Name:PARKER
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:LEEANN
Other - Last Name:CASSELL-PARKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:800 OAK ST
Mailing Address - Street 2:
Mailing Address - City:FARMVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:23901-1199
Mailing Address - Country:US
Mailing Address - Phone:434-315-2950
Mailing Address - Fax:434-315-2959
Practice Address - Street 1:800 OAK ST
Practice Address - Street 2:
Practice Address - City:FARMVILLE
Practice Address - State:VA
Practice Address - Zip Code:23901-1199
Practice Address - Country:US
Practice Address - Phone:434-315-2950
Practice Address - Fax:434-315-2959
Is Sole Proprietor?:No
Enumeration Date:2013-09-11
Last Update Date:2023-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024171187367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1558796359OtherTRICARE
VA1558796359Medicaid
VA1558796359Medicaid