Provider Demographics
NPI:1821464256
Name:PARKER, AMY LEA (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:AMY
Middle Name:LEA
Last Name:PARKER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2106 GRAND CAYMAN WAY
Mailing Address - Street 2:
Mailing Address - City:MESQUITE
Mailing Address - State:TX
Mailing Address - Zip Code:75149-5457
Mailing Address - Country:US
Mailing Address - Phone:972-978-6602
Mailing Address - Fax:
Practice Address - Street 1:2106 GRAND CAYMAN WAY
Practice Address - Street 2:
Practice Address - City:MESQUITE
Practice Address - State:TX
Practice Address - Zip Code:75149-5457
Practice Address - Country:US
Practice Address - Phone:972-978-6602
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-19
Last Update Date:2015-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant