1366869240 NPI number — DR. KIMBERLY PARKS M.D.

Table of content: DR. KIMBERLY PARKS M.D. (NPI 1366869240)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1366869240 NPI number — DR. KIMBERLY PARKS M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PARKS
Provider First Name:
KIMBERLY
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
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:
1366869240
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/20/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1 BAYLOR PLAZA
Provider Second Line Business Mailing Address:
DEPT OF PSYCHIATRY AND BEHAVIORAL SCIENCES, MS 350
Provider Business Mailing Address City Name:
HOUSTON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77030
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
713-798-5645
Provider Business Mailing Address Fax Number:
713-798-4089

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1504 TAUB LOOP
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HOUSTON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77030-1608
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
713-873-4709
Provider Business Practice Location Address Fax Number:
713-873-4938
Provider Enumeration Date:
03/28/2014

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: 2084P0802X , with the licence number:  R5914 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2084P0800X , with the licence number: R5914 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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