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1114172368 NPI number — ANGELA FAY PARKS P.A.

NPI Number: 1114172368
Health Care Provider/Practitioner: ANGELA FAY PARKS P.A.

Information about “1114172368” NPI (ANGELA FAY PARKS P.A.) exists in 1114172368 in HTML format HTML  |  1114172368 in plain Text format TXT  |  1114172368 in PDF (Portable Document Format) PDF  |  1114172368 in an XML format XML  formats.

NPI Number : 1114172368 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1114172368",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "PARKS",
    "FirstName": "ANGELA",
    "MiddleName": "FAY",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "P.A.",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "ARMOUR",
    "OtherFirstName": "ANGELA",
    "OtherMiddleName": "F",
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": "P.A.",
    "OtherLastNameTypeCode": "1",
    "FirstLineMailingAddress": "1015 N LEWELLEN ST",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "WICHITA",
    "MailingAddressStateName": "KS",
    "MailingAddressPostalCode": "67203-3568",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "316-393-9104",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "550 N HILLSIDE ST",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "WICHITA",
    "PracticeLocationAddressStateName": "KS",
    "PracticeLocationAddressPostalCode": "67214-4910",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "316-962-9207",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "12/01/2008",
    "LastUpdateDate": "08/08/2023",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "F",
    "Gender": "Female",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "363A00000X",
          "TaxonomyName": "Physician Assistant",
          "LicenseNumber": "T-02258",
          "LicenseNumberStateCode": "KS",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "363A00000X",
          "TaxonomyName": "Physician Assistant",
          "LicenseNumber": "4169",
          "LicenseNumberStateCode": "SC",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "363A00000X",
          "TaxonomyName": "Physician Assistant",
          "LicenseNumber": "1501255",
          "LicenseNumberStateCode": "KS",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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