Provider Demographics
NPI:1518937663
Name:PARKS, KIMBERLY RAE (O D)
Entity Type:Individual
Prefix:DR
First Name:KIMBERLY
Middle Name:RAE
Last Name:PARKS
Suffix:
Gender:F
Credentials:O D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3011 BELL RD
Mailing Address - Street 2:
Mailing Address - City:WHITE PINE
Mailing Address - State:TN
Mailing Address - Zip Code:37890-3102
Mailing Address - Country:US
Mailing Address - Phone:865-310-7565
Mailing Address - Fax:
Practice Address - Street 1:1903 MAPLE ST
Practice Address - Street 2:
Practice Address - City:WHITE PINE
Practice Address - State:TN
Practice Address - Zip Code:37890-3847
Practice Address - Country:US
Practice Address - Phone:865-761-0557
Practice Address - Fax:865-761-0417
Is Sole Proprietor?:No
Enumeration Date:2006-01-23
Last Update Date:2021-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2534152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist