Provider Demographics
NPI:1093396103
Name:PARKS, KELSEY NICOLE (MD)
Entity type:Individual
Prefix:
First Name:KELSEY
Middle Name:NICOLE
Last Name:PARKS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KELSEY
Other - Middle Name:NICOLE
Other - Last Name:HOEGH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3955 PARKLAWN AVE STE 120
Mailing Address - Street 2:
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55435-5660
Mailing Address - Country:US
Mailing Address - Phone:952-278-7000
Mailing Address - Fax:
Practice Address - Street 1:3955 PARKLAWN AVE STE 120
Practice Address - Street 2:
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55435-5660
Practice Address - Country:US
Practice Address - Phone:952-278-7000
Practice Address - Fax:952-278-6942
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-20
Last Update Date:2024-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN77153208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics