Provider Demographics
NPI:1134130453
Name:PARKER, MADELYN M (FPMHNP)
Entity type:Individual
Prefix:
First Name:MADELYN
Middle Name:M
Last Name:PARKER
Suffix:
Gender:F
Credentials:FPMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 18679
Mailing Address - Street 2:
Mailing Address - City:HATTIESBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39404-8679
Mailing Address - Country:US
Mailing Address - Phone:601-701-1906
Mailing Address - Fax:601-705-1952
Practice Address - Street 1:1415 COLLEGE DR
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:MS
Practice Address - Zip Code:39307-5345
Practice Address - Country:US
Practice Address - Phone:601-483-4821
Practice Address - Fax:601-485-0223
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2017-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR609927363LP0808X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS500001527Medicare ID - Type Unspecified
MSS90492Medicare UPIN