Provider Demographics
NPI:1851801195
Name:PARR, STELLAN J (PA-C)
Entity Type:Individual
Prefix:MR
First Name:STELLAN
Middle Name:J
Last Name:PARR
Suffix:
Gender:M
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 1:3400 DOUGLAS BLVD STE 170
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95661-4281
Mailing Address - Country:US
Mailing Address - Phone:855-446-8628
Mailing Address - Fax:
Practice Address - Street 1:3400 DOUGLAS BLVD STE 170
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661-4281
Practice Address - Country:US
Practice Address - Phone:855-446-8628
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-30
Last Update Date:2024-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA64227363A00000X, 2084P0800X
NY021540363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical