Provider Demographics
NPI:1659065290
Name:PARK, ANNIE KAY (ARNP FNP-C)
Entity Type:Individual
Prefix:
First Name:ANNIE
Middle Name:KAY
Last Name:PARK
Suffix:
Gender:F
Credentials:ARNP FNP-C
Other - Prefix:
Other - First Name:KAREN
Other - Middle Name:ANN
Other - Last Name:PARK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RNC
Mailing Address - Street 1:100 W 3RD AVE
Mailing Address - Street 2:
Mailing Address - City:ELLENSBURG
Mailing Address - State:WA
Mailing Address - Zip Code:98926-3354
Mailing Address - Country:US
Mailing Address - Phone:206-291-6553
Mailing Address - Fax:
Practice Address - Street 1:100 W 3RD AVE
Practice Address - Street 2:
Practice Address - City:ELLENSBURG
Practice Address - State:WA
Practice Address - Zip Code:98926-3354
Practice Address - Country:US
Practice Address - Phone:509-388-2345
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-06
Last Update Date:2023-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN000150149163WN0003X
WAAP61483923363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WN0003XNursing Service ProvidersRegistered NurseNeonatal, Low-Risk