Provider Demographics
NPI:1346935749
Name:PARKINSON NICKS, JESSICA J
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:J
Last Name:PARKINSON NICKS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:NIXI
Other - Middle Name:
Other - Last Name:NICKS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:4154 MARY ELLEN AVE
Mailing Address - Street 2:
Mailing Address - City:STUDIO CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91604-2211
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4154 MARY ELLEN AVE
Practice Address - Street 2:
Practice Address - City:STUDIO CITY
Practice Address - State:CA
Practice Address - Zip Code:91604-2211
Practice Address - Country:US
Practice Address - Phone:602-725-3171
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-10
Last Update Date:2023-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program