Individual
RAVEN PARKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
14805 FOREST RD STE 229, FOREST, VA 24551-5019
(434) 207-2337
Mailing address
27 STONEWALL RD, CONCORD, VA 24538-3070
(540) 986-5480
Taxonomy
Speciality
Code
Description
License number
State
207PE0004X
Emergency Medical Services (Emergency Medicine) Physician
00000000
VA
363A00000X
Physician Assistant
0000000
VA
363AM0700X
Medical Physician Assistant
Primary
0110-007699
VA
Other
Enumeration date
07/08/2020
Last updated
06/28/2024
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