Provider Demographics
NPI:1487971446
Name:PARKER, JESSICA KATHRUN (LAC, DAOM)
Entity type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:KATHRUN
Last Name:PARKER
Suffix:
Gender:F
Credentials:LAC, DAOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 CEDAR ST STE B
Mailing Address - Street 2:
Mailing Address - City:SANTA CRUZ
Mailing Address - State:CA
Mailing Address - Zip Code:95060-4358
Mailing Address - Country:US
Mailing Address - Phone:831-426-1093
Mailing Address - Fax:
Practice Address - Street 1:3515 GRAND AVE.
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94610-2037
Practice Address - Country:US
Practice Address - Phone:510-463-4304
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-04-29
Last Update Date:2024-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13468171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist