Individual
MRS. KELLY POTTER PARKS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
121 S FRONT ST, SEAFORD, DE 19973-3511
(302) 629-5030
(302) 629-5035
Mailing address
7817 GRACE CIR, SEAFORD, DE 19973-4337
(302) 628-3229
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
C5-0000165
DE
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
C5-0000165
STATE LICENSE NUMBER
DE
01
—
RXPA02015
STATE PRESCRIPTION NUMBER
DE
Enumeration date
04/04/2007
Last updated
08/16/2007
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