Basic Information
| Provider Information | |||||||||
| NPI: | 1225503394 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PARKER | ||||||||
| FirstName: | CHARISSA | ||||||||
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| Credential: | FNP-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5560 TENNYSON PKWY STE 120 | ||||||||
| Address2: | |||||||||
| City: | PLANO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 750243582 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9724689796 | ||||||||
| FaxNumber: | 2144944423 | ||||||||
| Practice Location | |||||||||
| Address1: | 3604 LIVE OAK ST STE 100 | ||||||||
| Address2: | |||||||||
| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 752046169 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2143582300 | ||||||||
| FaxNumber: | 2143666330 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/04/2018 | ||||||||
| LastUpdateDate: | 07/13/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/13/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084N0400X | AP137750 | TX | N | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology | 363LF0000X | AP137750 | TX | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | 363L00000X | AP137750 | TX | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
ID Information
| ID | Type | State | Issuer | Description | 840304 | 01 | TX | RN LICENSE | OTHER | AP137750 | 01 | TX | STATE LICENSE | OTHER |