Individual provider Active NPI

Cheryl Rose Parks, CRNA

  • Clinical Nurse Specialist
  • Frederick, MD
National Provider Identifier
1902880222
Registry record updated Mar 17, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Nurse SpecialistTaxonomy code 364S00000X
License
RO68640 Issued in MD
Practice address
45 Thomas Johnson Dr
Suite 207
Frederick, MD 21702-4425
Phone
(301) 694-3400
Fax
(301) 694-3620
NPI assigned
Nov 30, 2005
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 17, 2010

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Nurse Specialist 364S00000X RO68640 MD Primary

Addresses

Primary practice location

45 Thomas Johnson Dr
Suite 207
Frederick, MD 21702-4425

Mailing address

PO Box 790058
Saint Louis, MO 63179-0058
Phone (636) 549-2380

Other identifiers 4

IdentifierTypeStateIssuer
P00137653OtherMDMEDICARE RAILROAD (PTAN CJ8689)
P00687678OtherMDMEDICARE RAILROAD (PTAN DD6120)
S417-0007OtherDCCAREFIRST BCBS
KBC1CHOtherMDCAREFIRST BCBS

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Certified Registered Nurse

State licenses

LicenseStateTypeSpecialty
RO68640MDMDClinical Nurse Specialist

NPI Registry JSON

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

{
    "created_epoch": "1133308800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1268784000000",
    "number": "1902880222",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 790058",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631790058",
            "telephone_number": "636-549-2380",
            "fax_number": "314-569-5974"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "45 THOMAS JOHNSON DR",
            "address_2": "SUITE 207",
            "city": "FREDERICK",
            "state": "MD",
            "postal_code": "217024425",
            "telephone_number": "301-694-3400",
            "fax_number": "301-694-3620"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PARKS",
        "first_name": "CHERYL",
        "middle_name": "ROSE",
        "credential": "CRNA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-11-30",
        "last_updated": "2010-03-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "364S00000X",
            "taxonomy_group": "",
            "desc": "Clinical Nurse Specialist",
            "state": "MD",
            "license": "RO68640",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE RAILROAD (PTAN CJ8689)",
            "identifier": "P00137653",
            "state": "MD"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE RAILROAD (PTAN DD6120)",
            "identifier": "P00687678",
            "state": "MD"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAREFIRST BCBS",
            "identifier": "S417-0007",
            "state": "DC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAREFIRST BCBS",
            "identifier": "KBC1CH",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Frederick, MD

Sources for this page

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