Provider Demographics
NPI:1548273543
Name:PARKER, LORI J (LSA, CSFA)
Entity type:Individual
Prefix:
First Name:LORI
Middle Name:J
Last Name:PARKER
Suffix:
Gender:F
Credentials:LSA, CSFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10577 ROYAL FOREST DR
Mailing Address - Street 2:
Mailing Address - City:CONROE
Mailing Address - State:TX
Mailing Address - Zip Code:77303-2733
Mailing Address - Country:US
Mailing Address - Phone:936-217-7215
Mailing Address - Fax:
Practice Address - Street 1:10577 ROYAL FOREST DR
Practice Address - Street 2:
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:77303-2733
Practice Address - Country:US
Practice Address - Phone:936-217-7215
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-14
Last Update Date:2021-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX00F585/SA00006246ZC0007X
TXSA00006246Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246Z00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, Other
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXSA00006OtherTEXAS MEDICAL BOARD