Provider Demographics
NPI:1215935036
Name:PARKER, KIMBERLY KOYE (NP)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:KOYE
Last Name:PARKER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:KIMBERLY
Other - Middle Name:KOYE HILTON
Other - Last Name:PARKER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:APNP
Mailing Address - Street 1:1150 GOLDEN WAY
Mailing Address - Street 2:
Mailing Address - City:WATKINSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30677-7712
Mailing Address - Country:US
Mailing Address - Phone:706-612-9401
Mailing Address - Fax:706-612-9420
Practice Address - Street 1:1150 GOLDEN WAY
Practice Address - Street 2:
Practice Address - City:WATKINSVILLE
Practice Address - State:GA
Practice Address - Zip Code:30677-7712
Practice Address - Country:US
Practice Address - Phone:706-612-9401
Practice Address - Fax:706-612-9420
Is Sole Proprietor?:No
Enumeration Date:2005-07-14
Last Update Date:2022-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN117408363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000851694GMedicaid
GA000851694FMedicaid
GA50BBDCLMedicare ID - Type Unspecified