Provider Demographics
NPI:1932692282
Name:PARKER, MAGAN (CRNP)
Entity Type:Individual
Prefix:
First Name:MAGAN
Middle Name:
Last Name:PARKER
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4300 W MAIN ST STE 102
Mailing Address - Street 2:
Mailing Address - City:DOTHAN
Mailing Address - State:AL
Mailing Address - Zip Code:36305-1306
Mailing Address - Country:US
Mailing Address - Phone:334-793-9564
Mailing Address - Fax:334-340-2880
Practice Address - Street 1:4300 W MAIN ST STE 102
Practice Address - Street 2:
Practice Address - City:DOTHAN
Practice Address - State:AL
Practice Address - Zip Code:36305-1306
Practice Address - Country:US
Practice Address - Phone:334-793-9564
Practice Address - Fax:334-340-2880
Is Sole Proprietor?:No
Enumeration Date:2018-06-12
Last Update Date:2018-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-121631363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner