Provider Demographics
NPI:1255770673
Name:PARKS, JESSICA LYNN (APRN-NP)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:LYNN
Last Name:PARKS
Suffix:
Gender:F
Credentials:APRN-NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5566 S 56TH ST
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68516-1834
Mailing Address - Country:US
Mailing Address - Phone:402-423-3839
Mailing Address - Fax:
Practice Address - Street 1:5566 S 56TH ST
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68516-1834
Practice Address - Country:US
Practice Address - Phone:402-423-3839
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-19
Last Update Date:2018-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE111512363LF0000X
NE1909363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE47056474312Medicaid