Provider Demographics
NPI:1174512008
Name:PARKE, KRISTINE M (MD)
Entity Type:Individual
Prefix:
First Name:KRISTINE
Middle Name:M
Last Name:PARKE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:510 N GUADALUPE ST STE C1-C2
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87501-6510
Mailing Address - Country:US
Mailing Address - Phone:505-913-4660
Mailing Address - Fax:
Practice Address - Street 1:510 N GUADALUPE ST STE C1-C2
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87501-6510
Practice Address - Country:US
Practice Address - Phone:505-913-4660
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-13
Last Update Date:2012-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM20030112207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
202019234OtherPRESBYTERIAN HEALTH PLANS
15389OtherMOLINA
2362512OtherUHC
NMNM002A15OtherBCBS NM
10012787OtherLOVELACE
NM16929781Medicaid
NM16929781Medicaid
202019234OtherPRESBYTERIAN HEALTH PLANS
NMH99184Medicare UPIN