Provider Demographics
NPI:1285357822
Name:PARKES, KATIE ELAINE HARLAN
Entity type:Individual
Prefix:
First Name:KATIE
Middle Name:ELAINE HARLAN
Last Name:PARKES
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 1:2701 IMPERIAL DR SE
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35801-2232
Mailing Address - Country:US
Mailing Address - Phone:256-426-9027
Mailing Address - Fax:
Practice Address - Street 1:3809 SULLIVAN ST STE 3
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:AL
Practice Address - Zip Code:35758-2366
Practice Address - Country:US
Practice Address - Phone:256-325-0178
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-20
Last Update Date:2022-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-150209163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant