Provider Demographics
NPI:1356561997
Name:PARKER, KIMBERLY (PT)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:
Last Name:PARKER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26 VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:LAKEVILLE
Mailing Address - State:CT
Mailing Address - Zip Code:06039-2120
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:22 UPPER MAIN ST
Practice Address - Street 2:SUITE 7
Practice Address - City:SHARON
Practice Address - State:CT
Practice Address - Zip Code:06069-2083
Practice Address - Country:US
Practice Address - Phone:860-364-9840
Practice Address - Fax:860-364-1859
Is Sole Proprietor?:No
Enumeration Date:2007-04-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT003087174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQ34521OtherEMPIRE BC BS
CT080003087 CT 02OtherANTHEM BC BS
NY437133OtherMVP SPECIALIST