Provider Demographics
NPI:1982880142
Name:PARKER, KATHLEEN F
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:F
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 1:4864 E DIAMOND DR
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT
Mailing Address - State:AZ
Mailing Address - Zip Code:86301-5944
Mailing Address - Country:US
Mailing Address - Phone:928-778-2568
Mailing Address - Fax:
Practice Address - Street 1:4864 E DIAMOND DR
Practice Address - Street 2:
Practice Address - City:PRESCOTT
Practice Address - State:AZ
Practice Address - Zip Code:86301-5944
Practice Address - Country:US
Practice Address - Phone:928-778-2568
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-17
Last Update Date:2015-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist