Provider Demographics
NPI:1457701807
Name:PARK, JEE YEAH (PMHNP)
Entity Type:Individual
Prefix:
First Name:JEE YEAH
Middle Name:
Last Name:PARK
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:199 CHANDLER ST
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01609-3088
Mailing Address - Country:US
Mailing Address - Phone:508-860-7888
Mailing Address - Fax:508-796-7053
Practice Address - Street 1:199 CHANDLER ST
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01609-3088
Practice Address - Country:US
Practice Address - Phone:508-860-7888
Practice Address - Fax:508-796-7053
Is Sole Proprietor?:No
Enumeration Date:2016-06-16
Last Update Date:2022-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2322449363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health