Provider Demographics
NPI:1609262823
Name:PARKS PRACTITIONER AND CONSULTING SERVICES LLC
Entity Type:Organization
Organization Name:PARKS PRACTITIONER AND CONSULTING SERVICES LLC
Other - Org Name:PPCS
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:PARKS
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:334-333-6158
Mailing Address - Street 1:5 CANEBREAK PL
Mailing Address - Street 2:
Mailing Address - City:FAIRHOPE
Mailing Address - State:AL
Mailing Address - Zip Code:36532-6370
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:9640 SYLVANIA METAMORA RD
Practice Address - Street 2:
Practice Address - City:SYLVANIA
Practice Address - State:OH
Practice Address - Zip Code:43560-9485
Practice Address - Country:US
Practice Address - Phone:334-333-6158
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-14
Last Update Date:2023-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251J00000X
TN13235363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Single Specialty
No251J00000XAgenciesNursing CareGroup - Single Specialty