Provider Demographics
NPI:1740890698
Name:PARKER, KIMBERLY (CRNP)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:
Last Name:PARKER
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5750A SOUTHLAND DR
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36693-3316
Mailing Address - Country:US
Mailing Address - Phone:251-450-5916
Mailing Address - Fax:251-662-7297
Practice Address - Street 1:9518 US HIGHWAY 231
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:AL
Practice Address - Zip Code:35136-5214
Practice Address - Country:US
Practice Address - Phone:256-377-8008
Practice Address - Fax:251-662-7297
Is Sole Proprietor?:No
Enumeration Date:2020-08-05
Last Update Date:2022-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL3-000648363LF0000X, 363LP0808X
MSPARK-7YUYD4363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily