Provider Demographics
NPI:1982022422
Name:PARKER, JAMIE
Entity Type:Individual
Prefix:
First Name:JAMIE
Middle Name:
Last Name:PARKER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1312 S IVY ST
Mailing Address - Street 2:D
Mailing Address - City:NAMPA
Mailing Address - State:ID
Mailing Address - Zip Code:83686-6029
Mailing Address - Country:US
Mailing Address - Phone:208-989-8518
Mailing Address - Fax:
Practice Address - Street 1:1312 S IVY ST
Practice Address - Street 2:APT D
Practice Address - City:NAMPA
Practice Address - State:ID
Practice Address - Zip Code:83686-6029
Practice Address - Country:US
Practice Address - Phone:208-989-8518
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-02
Last Update Date:2014-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID00000000000126800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes126800000XDental ProvidersDental Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID000000000000000OtherHEALTH INSURANCE EXCHANGE ENROLLMENT