Provider Demographics
NPI:1962789651
Name:PARKER, MARISA LEIGH (ANP-BC, CVNP-BC)
Entity type:Individual
Prefix:MRS
First Name:MARISA
Middle Name:LEIGH
Last Name:PARKER
Suffix:
Gender:F
Credentials:ANP-BC, CVNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:450 BLOSSOM ST STE D
Mailing Address - Street 2:
Mailing Address - City:WEBSTER
Mailing Address - State:TX
Mailing Address - Zip Code:77598-4200
Mailing Address - Country:US
Mailing Address - Phone:832-905-5940
Mailing Address - Fax:
Practice Address - Street 1:450 BLOSSOM ST STE D
Practice Address - Street 2:
Practice Address - City:WEBSTER
Practice Address - State:TX
Practice Address - Zip Code:77598-4200
Practice Address - Country:US
Practice Address - Phone:832-905-5940
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-11-08
Last Update Date:2022-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1068733363LA2200X
TN16245363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health