Provider Demographics
NPI:1962190090
Name:PARKER, CASSANDRA SHIVAR (FNP-BC)
Entity type:Individual
Prefix:
First Name:CASSANDRA
Middle Name:SHIVAR
Last Name:PARKER
Suffix:
Gender:
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 BIG OAK ST
Mailing Address - Street 2:
Mailing Address - City:HILTON HEAD ISLAND
Mailing Address - State:SC
Mailing Address - Zip Code:29926-1140
Mailing Address - Country:US
Mailing Address - Phone:843-460-0962
Mailing Address - Fax:929-299-4428
Practice Address - Street 1:220 N MAIN ST STE 500
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29601-2129
Practice Address - Country:US
Practice Address - Phone:929-299-4428
Practice Address - Fax:929-299-4428
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-26
Last Update Date:2025-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC212045363LF0000X
GARN224536363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC1962190090Medicaid