Provider Demographics
NPI:1396927000
Name:PARKS, SHIRLEY (FNP)
Entity type:Individual
Prefix:
First Name:SHIRLEY
Middle Name:
Last Name:PARKS
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16841 N 31ST AVE
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85053-3012
Mailing Address - Country:US
Mailing Address - Phone:602-283-4019
Mailing Address - Fax:602-374-2209
Practice Address - Street 1:4650 W SUNSET BLVD
Practice Address - Street 2:MAILSTOP #60
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90027-6062
Practice Address - Country:US
Practice Address - Phone:323-361-7304
Practice Address - Fax:323-361-8030
Is Sole Proprietor?:No
Enumeration Date:2007-12-04
Last Update Date:2024-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA17681363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CARN483526Medicaid
CACL290WMedicare PIN
CARN483526Medicaid