Provider Demographics
NPI:1164757639
Name:PARKS, JAMIE LYNN (FNP-C)
Entity Type:Individual
Prefix:
First Name:JAMIE
Middle Name:LYNN
Last Name:PARKS
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1105 W FRANK AVE
Mailing Address - Street 2:SUITE 280
Mailing Address - City:LUFKIN
Mailing Address - State:TX
Mailing Address - Zip Code:75904-3303
Mailing Address - Country:US
Mailing Address - Phone:936-633-0630
Mailing Address - Fax:877-916-5022
Practice Address - Street 1:10 MEDICAL CENTER BLVD
Practice Address - Street 2:SUITE B
Practice Address - City:LUFKIN
Practice Address - State:TX
Practice Address - Zip Code:75904-3173
Practice Address - Country:US
Practice Address - Phone:936-633-0630
Practice Address - Fax:877-916-5022
Is Sole Proprietor?:No
Enumeration Date:2009-10-16
Last Update Date:2016-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX118615363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily