Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | 71002252A | IN |
NPI | 1013166115 |
---|---|
Provider Name | Jennifer Lynn Parkison |
First Address | Highland, IN 46322-3291 |
Second Address | Highland, IN 46322-3291 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/09/2008 |
Last Update Date | 12/09/2008 |