Provider Demographics
NPI:1245635622
Name:PARKER, JOE BEN (ARNP)
Entity type:Individual
Prefix:MR
First Name:JOE
Middle Name:BEN
Last Name:PARKER
Suffix:
Gender:M
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:3821 MASTHEAD ST NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87109-4679
Mailing Address - Country:US
Mailing Address - Phone:505-998-7400
Mailing Address - Fax:505-998-7741
Practice Address - Street 1:3821 MASTHEAD ST NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109-4679
Practice Address - Country:US
Practice Address - Phone:505-998-7400
Practice Address - Fax:505-998-7740
Is Sole Proprietor?:No
Enumeration Date:2014-10-28
Last Update Date:2023-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9388145363LA2200X
NMCNP-58760363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM2676036Medicaid