Provider Demographics
NPI:1568504058
Name:PARKER, KENNETH C (AUD)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:C
Last Name:PARKER
Suffix:
Gender:M
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6151 SHALLOWFORD RD STE 104
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37421-7803
Mailing Address - Country:US
Mailing Address - Phone:423-894-1133
Mailing Address - Fax:423-894-0292
Practice Address - Street 1:6151 SHALLOWFORD RD STE 104
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37421-7803
Practice Address - Country:US
Practice Address - Phone:423-894-1133
Practice Address - Fax:423-894-0292
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-13
Last Update Date:2022-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNA71231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3086884OtherBCBS ID
TN62-1066612OtherTAX ID