Provider Demographics
NPI:1568459329
Name:PARKS, SHERRY L (PA C)
Entity Type:Individual
Prefix:
First Name:SHERRY
Middle Name:L
Last Name:PARKS
Suffix:
Gender:F
Credentials:PA C
Other - Prefix:
Other - First Name:SHERRY
Other - Middle Name:L
Other - Last Name:THURSTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:401 1ST AVE
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:IA
Mailing Address - Zip Code:52342-2129
Mailing Address - Country:US
Mailing Address - Phone:641-484-2602
Mailing Address - Fax:641-484-6387
Practice Address - Street 1:401 1ST AVE
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:IA
Practice Address - Zip Code:52342-2129
Practice Address - Country:US
Practice Address - Phone:641-484-2602
Practice Address - Fax:641-484-6387
Is Sole Proprietor?:No
Enumeration Date:2005-10-05
Last Update Date:2010-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA001324363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA970019183OtherRR MEDICARE
IA970019183OtherRR MEDICARE
IAI3541Medicare PIN