Provider Demographics
NPI:1942234596
Name:KONKLE-PARKER, DEBORAH J (NP)
Entity type:Individual
Prefix:MISS
First Name:DEBORAH
Middle Name:J
Last Name:KONKLE-PARKER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:DEBORAH
Other - Middle Name:K
Other - Last Name:PARKER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2500 NORTH STATE STREET
Mailing Address - Street 2:UNIVERSITY PHYSICIANS PLLC
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39216-4500
Mailing Address - Country:US
Mailing Address - Phone:601-984-5560
Mailing Address - Fax:601-984-5565
Practice Address - Street 1:2500 NORTH STATE STREET
Practice Address - Street 2:DEPARTMENT OF MEDICINE/DIVISION OF INFECTIOUS DISEASE
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39216-4500
Practice Address - Country:US
Practice Address - Phone:601-984-5560
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2023-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR795171207RI0200X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MSP01745486OtherRAILROAD MEDICARE
MS0118355Medicaid
MS302I508628Medicare PIN
MS512I500055Medicare PIN
MSS40966Medicare UPIN
MS0118355Medicaid