Provider Demographics
NPI:1497714307
Name:PARKS, JOAN C (PA-C)
Entity Type:Individual
Prefix:
First Name:JOAN
Middle Name:C
Last Name:PARKS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1030
Mailing Address - Street 2:
Mailing Address - City:CHEROKEE
Mailing Address - State:NC
Mailing Address - Zip Code:28719-1030
Mailing Address - Country:US
Mailing Address - Phone:828-497-6318
Mailing Address - Fax:
Practice Address - Street 1:1570 ACQUONI RD
Practice Address - Street 2:SUITE 1
Practice Address - City:CHEROKEE
Practice Address - State:NC
Practice Address - Zip Code:28719
Practice Address - Country:US
Practice Address - Phone:828-497-6318
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0101121363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC891199YMedicaid
NC0101121OtherLICENSE
NCR49075Medicare UPIN
NC8TA065Medicare ID - Type Unspecified