Provider Demographics
NPI:1801561279
Name:PARK, HEE MYUNG (NP)
Entity type:Individual
Prefix:MR
First Name:HEE
Middle Name:MYUNG
Last Name:PARK
Suffix:
Gender:
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:435 2ND ST
Mailing Address - Street 2:
Mailing Address - City:NEWPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37821-3703
Mailing Address - Country:US
Mailing Address - Phone:423-625-2200
Mailing Address - Fax:
Practice Address - Street 1:435 2ND ST
Practice Address - Street 2:
Practice Address - City:NEWPORT
Practice Address - State:TN
Practice Address - Zip Code:37821-3703
Practice Address - Country:US
Practice Address - Phone:423-625-2200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-09
Last Update Date:2025-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5016100363L00000X
TN30051363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner