Provider Demographics
NPI:1972538395
Name:PARKER, KIMBERLY GASTON (NP)
Entity Type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:GASTON
Last Name:PARKER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:KIMBERLY
Other - Middle Name:LYNN
Other - Last Name:GASON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:140 BRIDGES RD STE F
Mailing Address - Street 2:
Mailing Address - City:MAULDIN
Mailing Address - State:SC
Mailing Address - Zip Code:29662-3260
Mailing Address - Country:US
Mailing Address - Phone:864-605-1449
Mailing Address - Fax:864-515-4820
Practice Address - Street 1:140 BRIDGES RD STE F
Practice Address - Street 2:
Practice Address - City:MAULDIN
Practice Address - State:SC
Practice Address - Zip Code:29662-3260
Practice Address - Country:US
Practice Address - Phone:864-605-1449
Practice Address - Fax:864-515-4820
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2023-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1360363L00000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
571049338OtherBLUE CROSS SC