Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0200X | Nurse Practitioner - Pediatrics | 5005192 | NC |
NPI | 1023316387 |
---|---|
Provider Name | Mr. Eric Parker |
First Address | Shelby, NC 28150-3565 |
Second Address | Shelby, NC 28150-3565 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/03/2011 |
Last Update Date | 07/02/2018 |