Provider Demographics
NPI:1356700496
Name:PARKS, JENNIFER LYNE (NP-C)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:LYNE
Last Name:PARKS
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:MRS
Other - First Name:JENNIFER
Other - Middle Name:LYNE
Other - Last Name:HELLEBUYCK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:16525 NW COUNTY ROAD 14781
Mailing Address - Street 2:
Mailing Address - City:DREXEL
Mailing Address - State:MO
Mailing Address - Zip Code:64742-9715
Mailing Address - Country:US
Mailing Address - Phone:816-805-3788
Mailing Address - Fax:
Practice Address - Street 1:805 N ORANGE ST
Practice Address - Street 2:
Practice Address - City:BUTLER
Practice Address - State:MO
Practice Address - Zip Code:64730-9382
Practice Address - Country:US
Practice Address - Phone:844-853-8937
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-02-17
Last Update Date:2024-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS77090363LF0000X
MO2015043229363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily