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General NPI Number Information
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NPI Number | 1639657679
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Entity Type | Individual
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Provider Name | THOMAS BRADLEY PARKES FNP-C
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Gender | Male
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Dates
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Enumeration Date | 08/01/2018
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Last Update Date | 11/16/2022
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Provider Practice Location Address
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Address Line | 1314 E WALNUT ST
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City | WASHINGTON
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State | IN
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Zip | 47501-2860
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Country | US
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Telephone | 812-254-2760
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Fax |
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Provider Business Mailing Address
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Address Line | 9819 HONEYSUCKLE LN
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City | LAWRENCEVILLE
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State | IL
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Zip | 62439-3436
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Country | US
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Telephone | 618-553-5656
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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 | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 28202678A
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License Number State | IN
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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 | 71008370A
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License Number State | IN
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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 | 71008370A
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License Number State | IN
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