Provider Demographics
NPI:1568426567
Name:PARKER, MICHAEL E (PA-C)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:E
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:PO BOX 5
Mailing Address - Street 2:
Mailing Address - City:HOHENWALD
Mailing Address - State:TN
Mailing Address - Zip Code:38462-0005
Mailing Address - Country:US
Mailing Address - Phone:931-796-7960
Mailing Address - Fax:931-796-7790
Practice Address - Street 1:20 S PARK ST
Practice Address - Street 2:
Practice Address - City:HOHENWALD
Practice Address - State:TN
Practice Address - Zip Code:38462-1413
Practice Address - Country:US
Practice Address - Phone:931-796-7960
Practice Address - Fax:931-796-7790
Is Sole Proprietor?:No
Enumeration Date:2006-04-14
Last Update Date:2010-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNPA0000000781363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4058697OtherBLUE CROSS OF TENNESSEE
TN3715488Medicaid
TN4058697OtherBLUE CROSS OF TENNESSEE
P30002Medicare UPIN
TN3715488Medicaid