Provider Demographics
NPI:1457625097
Name:PARKS, KATHLEEN BLAIR (CRNP)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:BLAIR
Last Name:PARKS
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 689022
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37068-9022
Mailing Address - Country:US
Mailing Address - Phone:629-235-9745
Mailing Address - Fax:615-628-6877
Practice Address - Street 1:1613 N MCKENZIE ST
Practice Address - Street 2:
Practice Address - City:FOLEY
Practice Address - State:AL
Practice Address - Zip Code:36535-2247
Practice Address - Country:US
Practice Address - Phone:251-949-3711
Practice Address - Fax:251-949-3715
Is Sole Proprietor?:No
Enumeration Date:2012-02-29
Last Update Date:2025-07-31
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AL1-103337363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS03982800Medicaid
AL243124Medicaid
AL146917Medicaid