Su Won Park, NP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

AP121597 Issued in TX

Practice address

825 S Crowley Rd
Crowley, TX 76036-3663

Phone

(866) 389-2727

NPI assigned

Mar 6, 2012

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in TX

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: su.won.park.1@12251.direct.athenahealth.com

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Minuteclinic Diagnostic of Texas PLLC

  • Family Nurse Practitioner
  • Round Rock, TX
  • NPI 1609076330
  Medicare reassignment NPD
• Minuteclinic Telehealth Services of Texas Association

  • Family Nurse Practitioner
  • Round Rock, TX
  • NPI 1922564301
  Medicare reassignment NPD
• Minuteclinic Diagnostic of Texas PLLC

  • Clinical Social Worker
  • Katy, TX
  • NPI 1740898188
  NPD

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

{
    "created_epoch": "1330992000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1742256000000",
    "number": "1265706402",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "825 S CROWLEY RD",
            "city": "CROWLEY",
            "state": "TX",
            "postal_code": "760363663"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "825 S CROWLEY RD",
            "city": "CROWLEY",
            "state": "TX",
            "postal_code": "760363663",
            "telephone_number": "866-389-2727"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PARK",
        "first_name": "SU WON",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-03-06",
        "last_updated": "2025-03-18",
        "certification_date": "2025-03-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "TX",
            "license": "745143",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "TX",
            "license": "AP121597",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jane Osuji
• Ta'Mar Lashaun Otini, LPC A
• Michelle Pannell, CST, LSA
• Parents Defeating Autism Today
• Jordan Elizabeth Park, RD,LD
• Terri Lynn Parks, MASSAGE THERAPIST
• Amy Parra
• Donna Marie Parrish, CD(DONA)
• Pass Counseling Services PLLC
• Timothy Pass, LCSW, LISW

• Family Nurse Practitioner in Crowley, TX
• Providers in Crowley, TX by specialty
• Family Nurse Practitioner in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 18, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.