Healthcare Provider Details

I. General information

NPI: 1093396103
Provider Name (Legal Business Name): KELSEY NICOLE PARKS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KELSEY NICOLE HOEGH

II. Dates (important events)

Enumeration Date: 04/20/2021
Last Update Date: 09/26/2024
Certification Date: 09/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3955 PARKLAWN AVE STE 120
EDINA MN
55435-5660
US

IV. Provider business mailing address

3955 PARKLAWN AVE STE 120
EDINA MN
55435-5660
US

V. Phone/Fax

Practice location:
  • Phone: 952-278-7000
  • Fax: 952-278-6942
Mailing address:
  • Phone: 952-278-7000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number77153
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: