Healthcare Provider Details

I. General information

NPI: 1356700496
Provider Name (Legal Business Name): JENNIFER LYNE PARKS NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MRS. JENNIFER LYNE HELLEBUYCK

II. Dates (important events)

Enumeration Date: 02/17/2016
Last Update Date: 11/05/2024
Certification Date: 11/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

805 N ORANGE ST
BUTLER MO
64730-9382
US

IV. Provider business mailing address

16525 NW COUNTY ROAD 14781
DREXEL MO
64742-9715
US

V. Phone/Fax

Practice location:
  • Phone: 844-853-8937
  • Fax:
Mailing address:
  • Phone: 816-805-3788
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number77090
License Number StateKS
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2015043229
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: