Individual
KENNETH S PARKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
ACNP
Contact information
Practice address
404 S 13TH AVE, LAUREL, MS 39440-4345
(601) 425-5544
(601) 425-5525
Mailing address
415 S 28TH AVE, HATTIESBURG, MS 39401-7246
(601) 425-5544
(601) 579-5240
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
R851488
MS
363LA2100X
Acute Care Nurse Practitioner
Primary
851488
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02684504
—
MS
01
—
3494930
AMERICAN ADMIN GROUP
MS
Enumeration date
08/27/2006
Last updated
06/18/2020
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