Basic Information
| Provider Information | |||||||||
| NPI: | 1366595167 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PARKER | ||||||||
| FirstName: | HOLLY | ||||||||
| MiddleName: | H | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 8023 | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | WILSON | ||||||||
| State: | NC | ||||||||
| PostalCode: | 278931023 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2524433133 | ||||||||
| FaxNumber: | 2524436726 | ||||||||
| Practice Location | |||||||||
| Address1: | 804 ENGLISH RD | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | ROCKY MOUNT | ||||||||
| State: | NC | ||||||||
| PostalCode: | 278046032 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2524433133 | ||||||||
| FaxNumber: | 2524436726 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/18/2007 | ||||||||
| LastUpdateDate: | 08/25/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 200300179 | NC | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 89134V4 | 05 | NC | MEDICAID |