Provider Demographics
NPI:1982146841
Name:PARKER, GLENDA PRITCHARD
Entity Type:Individual
Prefix:
First Name:GLENDA
Middle Name:PRITCHARD
Last Name:PARKER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3683 S FIRST ST
Mailing Address - Street 2:
Mailing Address - City:JENA
Mailing Address - State:LA
Mailing Address - Zip Code:71342-6409
Mailing Address - Country:US
Mailing Address - Phone:318-594-2033
Mailing Address - Fax:318-992-2267
Practice Address - Street 1:3683 S FIRST ST
Practice Address - Street 2:
Practice Address - City:JENA
Practice Address - State:LA
Practice Address - Zip Code:71342
Practice Address - Country:US
Practice Address - Phone:318-992-2263
Practice Address - Fax:318-992-2267
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-09
Last Update Date:2019-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA600723489Medicaid