Provider Demographics
NPI:1033457288
Name:PARKS, KIMBERLY D (CNM)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:D
Last Name:PARKS
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3900 JOE RAMSEY BLVD E STE E
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75401-7770
Mailing Address - Country:US
Mailing Address - Phone:903-454-1722
Mailing Address - Fax:903-454-1750
Practice Address - Street 1:3900 JOE RAMSEY BLVD E STE E
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:TX
Practice Address - Zip Code:75401-7770
Practice Address - Country:US
Practice Address - Phone:903-454-1722
Practice Address - Fax:903-454-1750
Is Sole Proprietor?:No
Enumeration Date:2013-01-23
Last Update Date:2022-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX13075367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife