Provider Demographics
NPI:1750489365
Name:PARKMAN, JILL A (CRNA)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:A
Last Name:PARKMAN
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 STOW CREEK RD
Mailing Address - Street 2:
Mailing Address - City:RUSTON
Mailing Address - State:LA
Mailing Address - Zip Code:71270-1664
Mailing Address - Country:US
Mailing Address - Phone:318-514-8701
Mailing Address - Fax:
Practice Address - Street 1:105 STOW CREEK RD
Practice Address - Street 2:
Practice Address - City:RUSTON
Practice Address - State:LA
Practice Address - Zip Code:71270-1664
Practice Address - Country:US
Practice Address - Phone:318-514-8701
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA084746367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA5X056Medicare ID - Type UnspecifiedMEDICARE