Provider Demographics
NPI:1407835739
Name:PARKER, CRYSTAL (PA)
Entity type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:
Last Name:PARKER
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3216 VINE ST STE 20
Mailing Address - Street 2:
Mailing Address - City:HAYS
Mailing Address - State:KS
Mailing Address - Zip Code:67601-1988
Mailing Address - Country:US
Mailing Address - Phone:785-261-7065
Mailing Address - Fax:785-261-7064
Practice Address - Street 1:3216 VINE ST STE 20
Practice Address - Street 2:
Practice Address - City:HAYS
Practice Address - State:KS
Practice Address - Zip Code:67601
Practice Address - Country:US
Practice Address - Phone:785-261-7065
Practice Address - Fax:785-261-7064
Is Sole Proprietor?:No
Enumeration Date:2006-01-13
Last Update Date:2018-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1500727363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100371920EMedicaid
P15961OtherMEDICARE UPIN
KSP01166852OtherMEDICARE RAILROAD
OKP00308422OtherMEDICARE RAILROAD
OKP15961Medicare UPIN