Provider Demographics
NPI:1770905507
Name:PARKS, AMY (RN)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:PARKS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1160 LONGREEN PARKWAY
Mailing Address - Street 2:LONGLEAF MIDDLE SCHOOL
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29229
Mailing Address - Country:US
Mailing Address - Phone:803-691-4870
Mailing Address - Fax:803-691-4043
Practice Address - Street 1:1160 LONGREEN PKWY
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29229-8189
Practice Address - Country:US
Practice Address - Phone:803-691-4870
Practice Address - Fax:803-691-4043
Is Sole Proprietor?:No
Enumeration Date:2014-01-14
Last Update Date:2014-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC80203163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse