Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103TA0400X | Addiction Psychologist (Substance Use Disorder) | 02855 | KY |
Y | 207Q00000X | Family Doctor | 02855 | KY |
NPI | 1558416677 |
---|---|
Provider Name | Mrs. Carman Ann Parker |
First Address | Pikeville, KY 41502-2917 |
Second Address | Pikeville, KY 41501-1546 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/01/2007 |
Last Update Date | 20/02/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
64108129 | (05) | KY |
I32088 | (02) |