Individual
MRS. MARY CHARLENE PARKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
1501 KINGS HWY, SHREVEPORT, LA 71103-4228
(318) 675-5000
Mailing address
1512 W KIRBY PL, SHREVEPORT, LA 71103-3822
(318) 675-5000
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
RN093600 AP04280
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1464597
—
LA
01
—
AP04280
STATE LICENSE
LA
Enumeration date
03/19/2007
Last updated
03/17/2014
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