MEDICARE: STACI PARKS-NASH

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	163W00000X	Registered Nurse	RN65374	NV
2	103K00000X	Behavior Analyst	RN65374	NV

General Provider Information

NPI Number	:	1558808212
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STACI PARKS-NASH

Provider Business Mailing Address
First Line	:	2713 LA MONTANA ST
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89108-6604
Country	:	US
Telephone Number	:	702-639-7580
Fax Number	:

Provider Business Practice Location Address
First Line	:	2713 LA MONTANA ST
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89108-6604
Country	:	US
Telephone Number	:	702-639-7580
Fax Number	:

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

Provider Enumeration Date	:	01/19/2017
Last Update Date	:	04/20/2017

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Directions to “ STACI PARKS-NASH ” Practice Location

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