MEDICARE: KATHY PARKES MSN, RN, IBCLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163WL0100X	Lactation Consultant (Registered Nurse)	589693	TX

General Provider Information

NPI Number	:	1194114611
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHY PARKES MSN, RN, IBCLC

Provider Business Mailing Address
First Line	:	5851 LOST CREEK ST.
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78247-1323
Country	:	US
Telephone Number	:	210-834-5399
Fax Number	:

Provider Business Practice Location Address
First Line	:	5851 LOST CREEK ST.
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78247-1323
Country	:	US
Telephone Number	:	210-834-5399
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/21/2015
Last Update Date	:	01/21/2015

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