Bryan Shawn Parks, C.R.N.A.

Primary specialty

Certified Registered Nurse AnesthetistTaxonomy code 367500000X

License

4704202241 Issued in MI

Practice address

408 Hazen St
Paw Paw, MI 49079-1019

Phone

(269) 657-3141

NPI assigned

Apr 10, 2007

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1176163200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1275609600000",
    "number": "1164645388",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10390 S 2ND ST",
            "city": "SCHOOLCRAFT",
            "state": "MI",
            "postal_code": "490879444",
            "telephone_number": "269-668-4787"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "408 HAZEN ST",
            "city": "PAW PAW",
            "state": "MI",
            "postal_code": "490791019",
            "telephone_number": "269-657-3141"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PARKS",
        "first_name": "BRYAN",
        "middle_name": "SHAWN",
        "name_prefix": "Mr.",
        "credential": "C.R.N.A.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-04-10",
        "last_updated": "2010-06-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "MI",
            "license": "4704202241",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBSM",
            "identifier": "430H060120",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Michelle Olson
• Jennifer Palm
• Jessica Palma
• Joel Scott Parish, BCBA
• Grace Elizabeth Parker
• Paw Paw Chiropractic Clinic
• Paw Paw Family Dentistry, PLC.
• Paw Paw Village Drug, Inc.
• Paw Paw Village Drug, Inc.
• David B Peirce, MD

• Certified Registered Nurse Anesthetist in Paw Paw, MI
• Providers in Paw Paw, MI by specialty
• Certified Registered Nurse Anesthetist in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 4, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.