Provider Demographics
NPI:1225621113
Name:PARKS, KINDRA VANESSA (MSN, APRN, PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:KINDRA
Middle Name:VANESSA
Last Name:PARKS
Suffix:
Gender:F
Credentials:MSN, APRN, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1923 ARGYLE ST
Mailing Address - Street 2:
Mailing Address - City:BUTTE
Mailing Address - State:MT
Mailing Address - Zip Code:59701-5505
Mailing Address - Country:US
Mailing Address - Phone:540-470-0842
Mailing Address - Fax:406-723-7117
Practice Address - Street 1:106 W BROADWAY ST
Practice Address - Street 2:
Practice Address - City:BUTTE
Practice Address - State:MT
Practice Address - Zip Code:59701-9224
Practice Address - Country:US
Practice Address - Phone:406-497-9090
Practice Address - Fax:406-723-7117
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-11
Last Update Date:2021-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT173832363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health