Individual
TARA LA-KESSA PARKS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
651 8TH AVE SE, CAIRO, GA 39828-3126
(904) 352-5767
Mailing address
651 8TH AVE SE, CAIRO, GA 39828-3126
(904) 352-5767
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
PN1225181
FL
Other
Enumeration date
12/29/2021
Last updated
12/29/2021
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