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General NPI Number Information
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NPI Number | 1356700496
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Entity Type | Individual
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Provider Name | JENNIFER LYNE PARKS NP-C
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Gender | Female
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Dates
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Enumeration Date | 02/17/2016
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Last Update Date | 11/05/2024
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Provider Practice Location Address
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Address Line | 805 N ORANGE ST
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City | BUTLER
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State | MO
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Zip | 64730-9382
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Country | US
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Telephone | 844-853-8937
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Fax |
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Provider Business Mailing Address
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Address Line | 16525 NW COUNTY ROAD 14781
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City | DREXEL
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State | MO
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Zip | 64742-9715
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Country | US
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Telephone | 816-805-3788
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 77090
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License Number State | KS
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 2015043229
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License Number State | MO
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