MEDICARE: HEATHER LYNN PARKS CNP

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
1	363L00000X	Nurse Practitioner	RX07145	OH
2	363L00000X	Nurse Practitioner	NP07145	OH
3	363L00000X	Nurse Practitioner	RN303012	OH

General Provider Information

NPI Number	:	1548227648
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HEATHER LYNN PARKS CNP

Provider Business Mailing Address
First Line	:	660 ACKERMAN 3RD FLOOR
Second Line	:	PO BOX 183103
City	:	COLUMBUS
State	:	OH
Zip	:	43218-3103
Country	:	US
Telephone Number	:	614-293-2391
Fax Number	:	614-293-6479

Provider Business Practice Location Address
First Line	:	2231 NORTH HIGH STREET
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43201
Country	:	US
Telephone Number	:	614-293-2700
Fax Number	:	614-293-2720

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/01/2006
Last Update Date	:	07/08/2007

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