Provider Demographics
NPI:1114996956
Name:PARKES, KARLA (ARNP)
Entity Type:Individual
Prefix:
First Name:KARLA
Middle Name:
Last Name:PARKES
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1218 DELANO AVE
Mailing Address - Street 2:
Mailing Address - City:WALHALLA
Mailing Address - State:ND
Mailing Address - Zip Code:58282-9519
Mailing Address - Country:US
Mailing Address - Phone:701-549-2888
Mailing Address - Fax:701-549-2828
Practice Address - Street 1:12272 106TH ST NE
Practice Address - Street 2:
Practice Address - City:WALHALLA
Practice Address - State:ND
Practice Address - Zip Code:58282-9519
Practice Address - Country:US
Practice Address - Phone:701-521-5122
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-15
Last Update Date:2024-04-26
Deactivation Date:2020-12-31
Deactivation Code:
Reactivation Date:2021-01-25
Provider Licenses
StateLicense IDTaxonomies
NDR50987363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND1114996956Medicaid