Healthcare Provider Details

I. General information

NPI: 1992081624
Provider Name (Legal Business Name): KATHRYN PARKS RN C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/26/2011
Last Update Date: 10/26/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

639 GRANITE ST
BRAINTREE MA
02184-5366
US

IV. Provider business mailing address

639 GRANITE ST
BRAINTREE MA
02184-5366
US

V. Phone/Fax

Practice location:
  • Phone: 781-356-8017
  • Fax: 781-356-8052
Mailing address:
  • Phone: 781-356-8017
  • Fax: 781-356-8052

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WA0400X
TaxonomyAddiction (Substance Use Disorder) Registered Nurse
License Number030361-21
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: