Provider Demographics
NPI:1114809092
Name:PARKS, JORDUN
Entity type:Individual
Prefix:
First Name:JORDUN
Middle Name:
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 1:2601 LITTLE ELM PKWY STE 1803
Mailing Address - Street 2:
Mailing Address - City:LITTLE ELM
Mailing Address - State:TX
Mailing Address - Zip Code:75068-2503
Mailing Address - Country:US
Mailing Address - Phone:973-433-3441
Mailing Address - Fax:
Practice Address - Street 1:2601 LITTLE ELM PKWY STE 1803
Practice Address - Street 2:
Practice Address - City:LITTLE ELM
Practice Address - State:TX
Practice Address - Zip Code:75068-2503
Practice Address - Country:US
Practice Address - Phone:973-433-3441
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-22
Last Update Date:2025-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX17860172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker