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NPI Code Detail

MEDICARE: POUNEH PARKS DNP, AGACNP-BC

MEDICARE: POUNEH PARKS DNP, AGACNP-BC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LA2100XAcute Care Nurse Practitioner1141087TX

General Provider Information

NPI Number : 1174379804
Entity Type Code : Individual
Provider Name (Legal Business Name) : POUNEH PARKS DNP, AGACNP-BC
Provider Business Mailing Address
First Line : 903 W MARTIN ST # MS 49-2
Second Line :
City : SAN ANTONIO
State : TX
Zip : 78207-0903
Country : US
Telephone Number : 201-358-0572
Fax Number : 210-358-5940
Provider Business Practice Location Address
First Line : 4502 MEDICAL DR STE 614
Second Line :
City : SAN ANTONIO
State : TX
Zip : 78229-4402
Country : US
Telephone Number : 210-643-7412
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/24/2024
Last Update Date : 03/04/2026

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