Provider Demographics
NPI:1235683517
Name:PARKER, CARI LYNN (NP)
Entity type:Individual
Prefix:
First Name:CARI
Middle Name:LYNN
Last Name:PARKER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2559 MEDICAL DR STE C
Mailing Address - Street 2:
Mailing Address - City:ALAMOGORDO
Mailing Address - State:NM
Mailing Address - Zip Code:88310-8704
Mailing Address - Country:US
Mailing Address - Phone:575-439-8220
Mailing Address - Fax:575-443-1818
Practice Address - Street 1:2559 MEDICAL DR STE C
Practice Address - Street 2:
Practice Address - City:ALAMOGORDO
Practice Address - State:NM
Practice Address - Zip Code:88310
Practice Address - Country:US
Practice Address - Phone:575-439-8220
Practice Address - Fax:575-443-1818
Is Sole Proprietor?:No
Enumeration Date:2016-08-04
Last Update Date:2019-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMCNP-03462363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM24558567Medicaid