Healthcare Provider Details

I. General information

NPI: 1376113787
Provider Name (Legal Business Name): CHELSEY ELIZABETH PARKS NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2021
Last Update Date: 06/24/2025
Certification Date: 06/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10710 OLD HIGHWAY 64
BOLIVAR TN
38008-3587
US

IV. Provider business mailing address

15001 S 1ST ST
MILAN TN
38358-5132
US

V. Phone/Fax

Practice location:
  • Phone: 731-658-6113
  • Fax:
Mailing address:
  • Phone: 731-613-2535
  • Fax: 731-613-2534

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number29672
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: