Individual
ANTANISHA L PARKS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
915 N GRAND BLVD, SAINT LOUIS, MO 63106-1621
(314) 652-4100
Mailing address
3502 GREEN BAY RD APT 207, NORTH CHICAGO, IL 60064-3616
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
—
—
363AS0400X
Surgical Physician Assistant
Primary
—
—
Other
Enumeration date
04/06/2026
Last updated
04/06/2026
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