1194704189 NPI number — MS. GAIL MARIE PARKER MPT

Table of content: MS. GAIL MARIE PARKER MPT (NPI 1194704189)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1194704189 NPI number — MS. GAIL MARIE PARKER MPT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PARKER
Provider First Name:
GAIL
Provider Middle Name:
MARIE
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
MPT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
HAYES
Provider Other First Name:
GAIL
Provider Other Middle Name:
MARIE
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1194704189
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1115 TAMARACK RD
Provider Second Line Business Mailing Address:
STE 800
Provider Business Mailing Address City Name:
OWENSBORO
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
42301
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
270-689-2341
Provider Business Mailing Address Fax Number:
270-689-2342

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1115 TAMARACK RD
Provider Second Line Business Practice Location Address:
STE 800
Provider Business Practice Location Address City Name:
OWENSBORO
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
42301
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-689-2341
Provider Business Practice Location Address Fax Number:
270-689-2342
Provider Enumeration Date:
01/10/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 87900544 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".




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