Provider Demographics
NPI:1942897566
Name:PARKS, CAROL ANN
Entity type:Individual
Prefix:
First Name:CAROL
Middle Name:ANN
Last Name:PARKS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6826 METUCHEN PL
Mailing Address - Street 2:
Mailing Address - City:REYNOLDSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:43068-4058
Mailing Address - Country:US
Mailing Address - Phone:614-657-5631
Mailing Address - Fax:
Practice Address - Street 1:6826 METUCHEN PL
Practice Address - Street 2:
Practice Address - City:REYNOLDSBURG
Practice Address - State:OH
Practice Address - Zip Code:43068-4058
Practice Address - Country:US
Practice Address - Phone:614-657-5631
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-29
Last Update Date:2020-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385H00000XRespite Care FacilityRespite Care