Provider Demographics
NPI:1568914695
Name:PARKS, KATHERINE LEE (CDM)
Entity Type:Individual
Prefix:MRS
First Name:KATHERINE
Middle Name:LEE
Last Name:PARKS
Suffix:
Gender:F
Credentials:CDM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2122 MUDDY HILL LN
Mailing Address - Street 2:
Mailing Address - City:FAIRBANKS
Mailing Address - State:AK
Mailing Address - Zip Code:99709-6215
Mailing Address - Country:US
Mailing Address - Phone:907-978-5160
Mailing Address - Fax:907-456-1511
Practice Address - Street 1:2122 MUDDY HILL LN
Practice Address - Street 2:
Practice Address - City:FAIRBANKS
Practice Address - State:AK
Practice Address - Zip Code:99709-6215
Practice Address - Country:US
Practice Address - Phone:907-978-5160
Practice Address - Fax:907-456-1511
Is Sole Proprietor?:No
Enumeration Date:2016-10-24
Last Update Date:2023-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK115451176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife