Provider Demographics
NPI:1447275524
Name:PARKER, PATTI ANNETTE (ANP)
Entity type:Individual
Prefix:
First Name:PATTI
Middle Name:ANNETTE
Last Name:PARKER
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 N SHILOH RD
Mailing Address - Street 2:
Mailing Address - City:GARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75042-5716
Mailing Address - Country:US
Mailing Address - Phone:972-487-5444
Mailing Address - Fax:972-485-3056
Practice Address - Street 1:800 N SHILOH RD
Practice Address - Street 2:
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75042-5716
Practice Address - Country:US
Practice Address - Phone:972-487-5444
Practice Address - Fax:972-485-3056
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2010-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX510126363LA2200X, 363LG0600X, 364SM0705X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No364SM0705XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistMedical-Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX140904702Medicaid
TX140904702Medicaid
TXS54139Medicare UPIN