Provider Demographics
NPI:1447373162
Name:PARKS, BETTY JEAN (RN)
Entity type:Individual
Prefix:
First Name:BETTY
Middle Name:JEAN
Last Name:PARKS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17960 HIGHWAY 76 N
Mailing Address - Street 2:
Mailing Address - City:SOMERVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38068-4558
Mailing Address - Country:US
Mailing Address - Phone:901-465-8837
Mailing Address - Fax:
Practice Address - Street 1:90 YUM YUM RD
Practice Address - Street 2:
Practice Address - City:SOMERVILLE
Practice Address - State:TN
Practice Address - Zip Code:38068-4541
Practice Address - Country:US
Practice Address - Phone:901-465-5245
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNRN0000029574163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse