Jennifer Ann Park, RN

Primary specialty

Registered NurseTaxonomy code 163W00000X

License

RN60754129 Issued in WA

Practice address

22026 20TH Ave SE Ste 101
Bothell, WA 98021-4449

Phone

(425) 672-7293

NPI assigned

Mar 24, 2022

Last updated

Mar 24, 2022By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Registered Nurse

State licenses

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

{
    "created_epoch": "1648080000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1648080000000",
    "number": "1790435733",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "22026 20TH AVE SE STE 101",
            "city": "BOTHELL",
            "state": "WA",
            "postal_code": "980214449",
            "telephone_number": "425-672-7293"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "22026 20TH AVE SE STE 101",
            "city": "BOTHELL",
            "state": "WA",
            "postal_code": "980214449",
            "telephone_number": "425-672-7293"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PARK",
        "first_name": "JENNIFER",
        "middle_name": "ANN",
        "credential": "RN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-03-24",
        "last_updated": "2022-03-24",
        "certification_date": "2022-03-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "WA",
            "license": "RN60754129",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Pan Pacific Health PPLC (Pan Pacific Health)
• Raisa Pankovets, DC
• Holly Louise Pankratz, LMHC
• Benjamin Ross Park, D.O.
• Debbie Park
• Youl N/a Park, AC
• Lili Parman
• Michelle Segall Parnes, OT
• Abigal Lynn Parris, SPEECH
• Rebecca Parrish, MS, LMFT

• Registered Nurse in Bothell, WA
• Providers in Bothell, WA by specialty
• Registered Nurse in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 24, 2022; 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.