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Individual
CRYSTAL PARKER
Active
Individual
CRYSTAL PARKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
1500727
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100371920E
—
KS
01
—
P01166852
MEDICARE RAILROAD
KS
01
—
P15961
MEDICARE UPIN
—
Enumeration date
01/13/2006
Last updated
08/14/2018
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