Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 10781 | MS |
Y | 2084N0402X | Child Neurologist | 10781 | MS |
NPI | 1053357749 |
---|---|
Provider Name | Colette C Parker |
First Address | Jackson, MS 39216-4500 |
Second Address | Jackson, MS 39216-4500 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/06/2006 |
Last Update Date | 15/05/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00019538 | (05) | MS |
1685127 | (05) | LA |
197520 | (05) | AL |