Provider Demographics
NPI:1144806191
Name:PARKS, JESSICA (LMT, BA)
Entity Type:Individual
Prefix:MS
First Name:JESSICA
Middle Name:
Last Name:PARKS
Suffix:
Gender:F
Credentials:LMT, BA
Other - Prefix:MS
Other - First Name:JESSICA
Other - Middle Name:
Other - Last Name:PARKS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:111 CUMBERLAND AVE APT 2
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28801-1757
Mailing Address - Country:US
Mailing Address - Phone:828-778-0444
Mailing Address - Fax:
Practice Address - Street 1:111 CUMBERLAND AVE APT 2
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28801-1757
Practice Address - Country:US
Practice Address - Phone:828-778-0444
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-21
Last Update Date:2021-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC05658225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist