Provider Demographics
NPI:1316944770
Name:PARKER, KATHLEEN ROSE (RN, PNP-BC)
Entity type:Individual
Prefix:MRS
First Name:KATHLEEN
Middle Name:ROSE
Last Name:PARKER
Suffix:
Gender:F
Credentials:RN, PNP-BC
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Mailing Address - Street 1:1555 LONG POND RD
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14626-4122
Mailing Address - Country:US
Mailing Address - Phone:585-368-4012
Mailing Address - Fax:585-723-7470
Practice Address - Street 1:1555 LONG POND RD
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14626-4122
Practice Address - Country:US
Practice Address - Phone:585-368-4012
Practice Address - Fax:585-723-7470
Is Sole Proprietor?:No
Enumeration Date:2005-06-30
Last Update Date:2022-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY380878-1363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
9512159OtherIHA
NY01877861Medicaid
000560245002OtherCOMM BLUE
NP0052OtherPREF CARE