Provider Demographics
NPI:1750153847
Name:HASTINGS-PARKE, MOLLY (BCCS)
Entity type:Individual
Prefix:
First Name:MOLLY
Middle Name:
Last Name:HASTINGS-PARKE
Suffix:
Gender:F
Credentials:BCCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9407 WESTPORT RD STE 105
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40241-2315
Mailing Address - Country:US
Mailing Address - Phone:502-423-3713
Mailing Address - Fax:
Practice Address - Street 1:9407 WESTPORT RD STE 105
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40241-2315
Practice Address - Country:US
Practice Address - Phone:502-423-3713
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-23
Last Update Date:2023-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation PractitionerGroup - Single Specialty