Provider Demographics
NPI:1255783650
Name:PARKER, PENNY ELAINE (FNP)
Entity type:Individual
Prefix:
First Name:PENNY
Middle Name:ELAINE
Last Name:PARKER
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 TAYLOR ST
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37208-2635
Mailing Address - Country:US
Mailing Address - Phone:229-379-7398
Mailing Address - Fax:
Practice Address - Street 1:44 JONES ST
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07103
Practice Address - Country:US
Practice Address - Phone:973-878-9020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-08
Last Update Date:2021-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN317415L163W00000X
NY703810-1163W00000X
NJ26NR09053300163W00000X
PASP017566363LF0000X
NY341152363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00695941Medicaid
NYW6L111Medicare Oscar/Certification
WI331952Medicare Oscar/Certification
NYG100000410Medicare Oscar/Certification
WI331009Medicare Oscar/Certification
WI331945Medicare Oscar/Certification
WI331043Medicare Oscar/Certification
WI331943Medicare Oscar/Certification
WI331954Medicare Oscar/Certification
NY00695941Medicaid
WI331058Medicare Oscar/Certification
WI331944Medicare Oscar/Certification
WI331946Medicare Oscar/Certification
WI331947Medicare Oscar/Certification