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General NPI Number Information
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NPI Number | 1568852317
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Entity Type | Individual
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Provider Name | SONG Y. PARK NP-C
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Gender | Female
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Dates
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Enumeration Date | 02/02/2015
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Last Update Date | 01/23/2025
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Provider Practice Location Address
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Address Line | 8588 KATY FWY STE 226A
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City | HOUSTON
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State | TX
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Zip | 77024-1881
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Country | US
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Telephone | 713-532-6884
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Fax | 713-532-5756
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Provider Business Mailing Address
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Address Line | 23320 HIGHWAY 99
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City | EDMONDS
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State | WA
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Zip | 98026-8744
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Country | US
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Telephone | 425-640-5500
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | AP61211573
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License Number State | WA
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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 | RN219551
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License Number State | GA
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Taxonomy #3
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 1185938
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License Number State | TX
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