1710202635 NPI number — MRS. JESSICA JANEA PARKS L.M.P

Table of content: MRS. JESSICA JANEA PARKS L.M.P (NPI 1710202635)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1710202635 NPI number — MRS. JESSICA JANEA PARKS L.M.P

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PARKS
Provider First Name:
JESSICA
Provider Middle Name:
JANEA
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
L.M.P
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1710202635
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/03/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
15232 SE 272ND ST
Provider Second Line Business Mailing Address:
#10
Provider Business Mailing Address City Name:
KENT
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98042-4240
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
206-455-3434
Provider Business Mailing Address Fax Number:
253-631-4786

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
15220 SE 272ND ST
Provider Second Line Business Practice Location Address:
SUITE D
Provider Business Practice Location Address City Name:
KENT
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98042-4241
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-631-7933
Provider Business Practice Location Address Fax Number:
253-631-4786
Provider Enumeration Date:
04/03/2010

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 172V00000X , with the licence number:  MA60137544 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2024 www.npivalidator.com