Provider Demographics
NPI:1710440722
Name:PARKER, ANDREA DENISE (NP)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:DENISE
Last Name:PARKER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5133 OSAGE CIR
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28269-4693
Mailing Address - Country:US
Mailing Address - Phone:612-799-6509
Mailing Address - Fax:
Practice Address - Street 1:5133 OSAGE CIR
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28269-4693
Practice Address - Country:US
Practice Address - Phone:612-799-6509
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-08
Last Update Date:2022-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCS0MZF4363LF0000X
NC5011789363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily