Provider Demographics
NPI:1144917923
Name:PARKER, KIM L (LSW)
Entity type:Individual
Prefix:
First Name:KIM
Middle Name:L
Last Name:PARKER
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1825 PINION RD STE A
Mailing Address - Street 2:
Mailing Address - City:ELKO
Mailing Address - State:NV
Mailing Address - Zip Code:89801-8319
Mailing Address - Country:US
Mailing Address - Phone:775-738-8021
Mailing Address - Fax:775-738-8842
Practice Address - Street 1:1825 PINION RD STE A
Practice Address - Street 2:
Practice Address - City:ELKO
Practice Address - State:NV
Practice Address - Zip Code:89801-8319
Practice Address - Country:US
Practice Address - Phone:775-738-8021
Practice Address - Fax:775-738-8842
Is Sole Proprietor?:No
Enumeration Date:2023-04-20
Last Update Date:2023-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV9213-S171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator