| Doctor Name: | JACKIE J PARNELL |
| NPI Number: | 1639169337 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | PA |
| License Number: | 552 |
| Business Practice Address: | 607 S Broadway Coweta, OK - 744295000 |
| Business Phone Number: | 9184865564 |
| Business Fax Number: | 9184863284 |
| Mailing Address: | 15187 W Grandview Rd, TAHLEQUAH |
| State: | OK |
| Postal Code: | 744641118 |
| Phone Number: | 9183162200 |
| Fax Number: | |
| NPI Enumeration Date: | 10/24/2005 |
| NPI Last Update Date: | 09/19/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363AM0700X |
| License Number: | 552 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | OK |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Physician Assistant |
| Taxonomy Specialization: | Medical |
| Taxonomy Definition: | |