Provider Demographics
NPI:1205516804
Name:PARKS, TYNESHA
Entity type:Individual
Prefix:
First Name:TYNESHA
Middle Name:
Last Name:PARKS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1423 KITTYHAWK DR
Mailing Address - Street 2:
Mailing Address - City:LITTLE ELM
Mailing Address - State:TX
Mailing Address - Zip Code:75068-8466
Mailing Address - Country:US
Mailing Address - Phone:469-386-4246
Mailing Address - Fax:
Practice Address - Street 1:26919 E HWY 380
Practice Address - Street 2:SUITE 204- 208
Practice Address - City:LITTLE ELM
Practice Address - State:TX
Practice Address - Zip Code:75068-8466
Practice Address - Country:US
Practice Address - Phone:469-521-9560
Practice Address - Fax:469-621-1802
Is Sole Proprietor?:No
Enumeration Date:2023-07-19
Last Update Date:2023-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator