Provider Demographics
NPI:1972561009
Name:PARRIS, VALENTINO ISAAC (FNP)
Entity type:Individual
Prefix:MR
First Name:VALENTINO
Middle Name:ISAAC
Last Name:PARRIS
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:206 3RD ST
Mailing Address - Street 2:
Mailing Address - City:NEW LLANO
Mailing Address - State:LA
Mailing Address - Zip Code:71461-9722
Mailing Address - Country:US
Mailing Address - Phone:760-267-4652
Mailing Address - Fax:
Practice Address - Street 1:1585 3RD STREET
Practice Address - Street 2:BAYNE-JONES HOSPITAL,
Practice Address - City:FORT POLK
Practice Address - State:LA
Practice Address - Zip Code:71459-5110
Practice Address - Country:US
Practice Address - Phone:337-531-3349
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-01
Last Update Date:2013-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI51419163W00000X
HI62291363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse