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Individual
JAMIE PARK
Active
Individual
JAMIE PARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
—
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
03853756
—
MS
05
—
2119958
—
LA
Enumeration date
11/02/2009
Last updated
01/24/2011
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