Provider Demographics
NPI:1306454442
Name:PARKER, CRIS A (NP)
Entity type:Individual
Prefix:
First Name:CRIS
Middle Name:A
Last Name:PARKER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 CLAIBORNE ST
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:MS
Mailing Address - Zip Code:39110-4561
Mailing Address - Country:US
Mailing Address - Phone:501-339-3363
Mailing Address - Fax:
Practice Address - Street 1:102 LEXINGTON DR STE 100
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:MS
Practice Address - Zip Code:39110-6952
Practice Address - Country:US
Practice Address - Phone:601-973-1688
Practice Address - Fax:601-973-1690
Is Sole Proprietor?:No
Enumeration Date:2020-07-15
Last Update Date:2022-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS903987363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily