Provider Demographics
NPI:1740339423
Name:PARKER, BERTHA
Entity type:Individual
Prefix:MISS
First Name:BERTHA
Middle Name:
Last Name:PARKER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:BERTHA
Other - Middle Name:L
Other - Last Name:MILLER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:7957 RED BEAN DR
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32526-2926
Mailing Address - Country:US
Mailing Address - Phone:850-549-5581
Mailing Address - Fax:850-290-0135
Practice Address - Street 1:7957 RED BEAN DR
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32526-2926
Practice Address - Country:US
Practice Address - Phone:850-549-5581
Practice Address - Fax:850-290-0135
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-10
Last Update Date:2023-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL677619196Medicaid