J & T Park Enterprises, LTD.

Primary specialty

Registered DietitianTaxonomy code 133V00000X

License

DT04601 Issued in TX

Legal business name

J & T PARK ENTERPRISES, LTD.

Practice address

788 Cooks Corner Rd
Pottsboro, TX 75076-6042

Phone

(806) 341-8883

NPI assigned

Jun 21, 2012

Organization subpart

No

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

Authorized official

Name

Mrs. Victoria Cuccia Park, R.D. L.D.NPI 1356573166

Title

Registered Dietitian

Phone

(806) 341-8883

Specialties & licenses 1

Addresses

Other identifiers 2

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Victoria C Park, RD

  • Registered Dietitian
  • Denison, TX
  • NPI 1356573166

  Dietitian, Registered

  NPD Authorized official

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

{
    "created_epoch": "1340236800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1344816000000",
    "number": "1457614612",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "788 COOKS CORNER RD",
            "city": "POTTSBORO",
            "state": "TX",
            "postal_code": "750766042",
            "telephone_number": "806-341-8883"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "788 COOKS CORNER RD",
            "city": "POTTSBORO",
            "state": "TX",
            "postal_code": "750766042",
            "telephone_number": "806-341-8883"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "J & T PARK ENTERPRISES, LTD.",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-06-21",
        "last_updated": "2012-08-13",
        "status": "A",
        "authorized_official_last_name": "PARK",
        "authorized_official_first_name": "VICTORIA",
        "authorized_official_middle_name": "CUCCIA",
        "authorized_official_title_or_position": "REGISTERED DIETITIAN",
        "authorized_official_telephone_number": "806-341-8883",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "R.D. L.D."
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dietitian, Registered",
            "state": "TX",
            "license": "DT04601",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1356573166",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN",
            "identifier": "TXB154636",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Family Pharmacy of Pottsboro
• Arwinder Gill
• Andreen Mary Grigerek-Jackson
• Robert L. Hawkins, D.D.S.
• Donna Lynn Higginbotham-Buttrill
• Michael Arthur Kennedy, PA-C
• Julie Kincaid, FNP-C
• Lake Texoma Chiropractic
• Lake Texoma Health Clinic, PLLC
• James Boothby Leblanc, M.ED., LPC

• Registered Dietitian in Pottsboro, TX
• Providers in Pottsboro, TX by specialty
• Registered Dietitian in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 13, 2012; 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.