Provider Demographics
NPI:1952713356
Name:PARKER, HOLLY ALYSE (PA-C)
Entity Type:Individual
Prefix:
First Name:HOLLY
Middle Name:ALYSE
Last Name:PARKER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4120 W MEMORIAL RD STE 102
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73120-9322
Mailing Address - Country:US
Mailing Address - Phone:405-749-4205
Mailing Address - Fax:405-749-4248
Practice Address - Street 1:4120 W MEMORIAL RD STE 102
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73120-9322
Practice Address - Country:US
Practice Address - Phone:405-749-4205
Practice Address - Fax:405-749-4248
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-20
Last Update Date:2022-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4874363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant