Provider Demographics
NPI:1790521870
Name:PARKE, ERNEST J
Entity type:Individual
Prefix:
First Name:ERNEST
Middle Name:J
Last Name:PARKE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1353 W MAIN ST STE 100
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40508-2065
Mailing Address - Country:US
Mailing Address - Phone:859-245-2400
Mailing Address - Fax:859-245-2443
Practice Address - Street 1:1353 W MAIN ST STE 100
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40508-2065
Practice Address - Country:US
Practice Address - Phone:859-245-2400
Practice Address - Fax:859-245-2443
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-08
Last Update Date:2024-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Single Specialty