Provider Demographics
NPI:1518214865
Name:PARKS, ADRIENNE D (PAC)
Entity Type:Individual
Prefix:MRS
First Name:ADRIENNE
Middle Name:D
Last Name:PARKS
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1441 N GARDNER ST
Mailing Address - Street 2:
Mailing Address - City:SCOTTSBURG
Mailing Address - State:IN
Mailing Address - Zip Code:47170-7751
Mailing Address - Country:US
Mailing Address - Phone:812-752-4055
Mailing Address - Fax:812-752-4188
Practice Address - Street 1:1441 N GARDNER ST
Practice Address - Street 2:
Practice Address - City:SCOTTSBURG
Practice Address - State:IN
Practice Address - Zip Code:47170-7751
Practice Address - Country:US
Practice Address - Phone:812-752-4055
Practice Address - Fax:812-752-4188
Is Sole Proprietor?:No
Enumeration Date:2012-08-06
Last Update Date:2012-08-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IN10001411A363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant