Provider Demographics
NPI:1235762782
Name:PARKS, MITCHELL J (DNP, ARNP, FNP-BC)
Entity Type:Individual
Prefix:
First Name:MITCHELL
Middle Name:J
Last Name:PARKS
Suffix:
Gender:M
Credentials:DNP, ARNP, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1350 N GRANT ST
Mailing Address - Street 2:
Mailing Address - City:KENNEWICK
Mailing Address - State:WA
Mailing Address - Zip Code:99336-1355
Mailing Address - Country:US
Mailing Address - Phone:509-735-2014
Mailing Address - Fax:
Practice Address - Street 1:1350 N GRANT ST
Practice Address - Street 2:
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99336-1355
Practice Address - Country:US
Practice Address - Phone:509-735-2014
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-12
Last Update Date:2023-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN60464733163W00000X
WAAP61167472363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse