Provider Demographics
NPI:1992426845
Name:PARKS, JEREME LYNN (DNP, APRN)
Entity type:Individual
Prefix:MS
First Name:JEREME
Middle Name:LYNN
Last Name:PARKS
Suffix:
Gender:F
Credentials:DNP, APRN
Other - Prefix:
Other - First Name:JEREME
Other - Middle Name:LYNN
Other - Last Name:SWENSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:345 SMITH AVE N
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55102-2346
Mailing Address - Country:US
Mailing Address - Phone:612-813-6000
Mailing Address - Fax:651-220-6707
Practice Address - Street 1:345 SMITH AVE N
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55102-2346
Practice Address - Country:US
Practice Address - Phone:612-813-6000
Practice Address - Fax:651-220-6707
Is Sole Proprietor?:No
Enumeration Date:2022-09-08
Last Update Date:2024-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR1682757163WP0808X
MN9601363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health