Provider Demographics
NPI:1790416956
Name:PARKER, KATIE NICHOLE
Entity Type:Individual
Prefix:
First Name:KATIE
Middle Name:NICHOLE
Last Name:PARKER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KATIE
Other - Middle Name:N
Other - Last Name:GLENN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3642 KOA CAMPGROUND RD
Mailing Address - Street 2:
Mailing Address - City:TOOMSUBA
Mailing Address - State:MS
Mailing Address - Zip Code:39364-9543
Mailing Address - Country:US
Mailing Address - Phone:601-616-9343
Mailing Address - Fax:
Practice Address - Street 1:6600 POPLAR SPRINGS DR
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:MS
Practice Address - Zip Code:39305-1105
Practice Address - Country:US
Practice Address - Phone:601-482-5561
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-20
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist