Provider Demographics
NPI:1770736092
Name:IDADA-PARKER, VALERIE BENEDICTA (DNP, PMHNP-BC, FNP)
Entity type:Individual
Prefix:DR
First Name:VALERIE
Middle Name:BENEDICTA
Last Name:IDADA-PARKER
Suffix:
Gender:F
Credentials:DNP, PMHNP-BC, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4819 EMPEROR BLVD STE 423
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27703-0089
Mailing Address - Country:US
Mailing Address - Phone:919-308-2339
Mailing Address - Fax:
Practice Address - Street 1:4819 EMPEROR BLVD # 423
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27703-0089
Practice Address - Country:US
Practice Address - Phone:919-308-2339
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-10-30
Last Update Date:2024-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC201294363LP2300X, 363LP0808X, 363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7000572Medicaid