Jenny Park

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

License

5009817 Issued in NC

Practice address

1718 E 4TH St Ste 807
Charlotte, NC 28204-3280

Phone

(704) 316-3297

NPI assigned

May 28, 2013

Last updated

Mar 17, 2018By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

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

{
    "created_epoch": "1369699200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1521244800000",
    "number": "1497192728",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 60447",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282600447",
            "telephone_number": "704-384-7840"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1718 E 4TH ST STE 807",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282043280",
            "telephone_number": "704-316-3297"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "525 e 70th st ste 307",
            "address_purpose": "LOCATION",
            "city": "new york",
            "state": "NY",
            "postal_code": "10065",
            "country_code": "US",
            "telephone_number": "646-962-7950",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "525 e 70th st ste 307",
            "address_purpose": "LOCATION",
            "city": "new york",
            "state": "NY",
            "postal_code": "10065",
            "country_code": "US",
            "telephone_number": "646-962-7950",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PARK",
        "first_name": "JENNY",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2013-05-28",
        "last_updated": "2018-03-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "NC",
            "license": "5009817",
            "primary": true
        },
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "NV",
            "license": "APRN002222",
            "primary": false
        },
        {
            "code": "363LP2300X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Primary Care",
            "state": "NY",
            "license": "F3064361",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Park Road Health and Wellness Inc
• Park Village Rehab and Health, Inc. (Peak Resources Charlotte)
• Carolyn Jean Park, MD
• Ellen Park, BCBA, LBA
• Esther Jane Park, PHARM.D.
• Ji Hee Park, PHARMD
• Timothy Park, M.D.
• Parker & Co. Wellness Group, LLC
• Laura Rose Parker Beck
• Parker Physical Therapy, Inc.

• Nurse Practitioner in Charlotte, NC
• Providers in Charlotte, NC by specialty
• Nurse Practitioner in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2018; 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.