Provider Demographics
NPI:1871899062
Name:PARKER, BRENDA CAROL (PHD)
Entity type:Individual
Prefix:DR
First Name:BRENDA
Middle Name:CAROL
Last Name:PARKER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:815 JOHN HARPER HIGHWAY
Mailing Address - Street 2:STE 13
Mailing Address - City:PIONEER VILLAGE
Mailing Address - State:KY
Mailing Address - Zip Code:40165-7463
Mailing Address - Country:US
Mailing Address - Phone:502-504-5231
Mailing Address - Fax:502-504-5205
Practice Address - Street 1:815 JOHN HARPER RD UNIT 13
Practice Address - Street 2:
Practice Address - City:PIONEER VILLAGE
Practice Address - State:KY
Practice Address - Zip Code:40165-7463
Practice Address - Country:US
Practice Address - Phone:502-504-5231
Practice Address - Fax:502-504-5205
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-04
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY129682103T00000X, 103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100315910Medicaid
50109798OtherPASSPORT GROUP ID