Provider Demographics
NPI:1629407945
Name:PARKER, JESSICA RAE (PA-C)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:RAE
Last Name:PARKER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:117 E MAIN ST
Mailing Address - Street 2:SUITE A 100
Mailing Address - City:PAYSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85541-5293
Mailing Address - Country:US
Mailing Address - Phone:928-474-1714
Mailing Address - Fax:928-468-7644
Practice Address - Street 1:117 E MAIN ST
Practice Address - Street 2:SUITE A 100
Practice Address - City:PAYSON
Practice Address - State:AZ
Practice Address - Zip Code:85541-5293
Practice Address - Country:US
Practice Address - Phone:928-474-1714
Practice Address - Fax:928-468-7644
Is Sole Proprietor?:No
Enumeration Date:2013-11-07
Last Update Date:2015-02-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IDPA-1113363A00000X
AZ5518363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant