Healthcare Provider Details

I. General information

NPI: 1437893336
Provider Name (Legal Business Name): JACQUELINE NICOLE PARKS APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/26/2022
Last Update Date: 04/16/2024
Certification Date: 04/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 TUNNEL RD
ASHEVILLE NC
28805-2576
US

IV. Provider business mailing address

1100 TUNNEL RD
ASHEVILLE NC
28805-2576
US

V. Phone/Fax

Practice location:
  • Phone: 828-298-7911
  • Fax: 828-299-5897
Mailing address:
  • Phone: 828-298-7911
  • Fax: 828-299-5897

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number31649
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number31649
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: