Provider Demographics
NPI:1558902106
Name:PARKER, DESIREE A (LVN)
Entity Type:Individual
Prefix:
First Name:DESIREE
Middle Name:A
Last Name:PARKER
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5201 COLLIN MCKINNEY PKWY APT 6301
Mailing Address - Street 2:
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75070-3369
Mailing Address - Country:US
Mailing Address - Phone:501-960-6572
Mailing Address - Fax:
Practice Address - Street 1:5201 COLLIN MCKINNEY PKWY APT 6301
Practice Address - Street 2:
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75070-3369
Practice Address - Country:US
Practice Address - Phone:501-960-6572
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-04
Last Update Date:2019-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARL048642164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes164X00000XNursing Service ProvidersLicensed Vocational NurseGroup - Multi-Specialty