Individual
JACOB A PARKS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
4475 S EASTERN AVE, LAS VEGAS, NV 89119-7826
(702) 877-5199
Mailing address
PO BOX 35380, LAS VEGAS, NV 89133-5380
(702) 877-5199
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA0492
NV
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
11/06/2020
Last updated
01/14/2021
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