Provider Demographics
NPI:1225345432
Name:PARKS, KAYLEIGH A (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:KAYLEIGH
Middle Name:A
Last Name:PARKS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MISS
Other - First Name:KAYLEIGH
Other - Middle Name:A
Other - Last Name:WOLFE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:1601 CLINT MOORE RD STE 212
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33487-5716
Mailing Address - Country:US
Mailing Address - Phone:561-939-0177
Mailing Address - Fax:570-387-1955
Practice Address - Street 1:1601 CLINT MOORE RD STE 212
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33487-5716
Practice Address - Country:US
Practice Address - Phone:561-939-0177
Practice Address - Fax:561-338-6271
Is Sole Proprietor?:No
Enumeration Date:2010-09-09
Last Update Date:2018-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOA002528363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant