Cecilia Park, FNP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

RN240365 Issued in GA

Practice address

3636 Satellite Blvd
#4A
Duluth, GA 30096-4590

Phone

(470) 336-9635

NPI assigned

Dec 21, 2012

Sex

Female

Sole proprietor

Yes

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 NY

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

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: cpark455337@nyumc.direct-ci.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.

• Optum Urgent Care, PLLC

  • Urgent Care Clinic/Center
  • Jericho, NY
  • NPI 1285975797
  Medicare reassignment NPD

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

{
    "created_epoch": "1356048000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1486944000000",
    "number": "1992041859",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2366 HARSHAW AVE",
            "city": "LAWRENCEVILLE",
            "state": "GA",
            "postal_code": "300438209",
            "telephone_number": "470-336-9635"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3636 SATELLITE BLVD",
            "address_2": "#4A",
            "city": "DULUTH",
            "state": "GA",
            "postal_code": "300964590",
            "telephone_number": "470-336-9635"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PARK",
        "first_name": "CECILIA",
        "credential": "FNP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2012-12-21",
        "last_updated": "2017-02-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "GA",
            "license": "CHIR008961",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "GA",
            "license": "RN240365",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Destiny Lanise Palmore
• Amy J Pancake, RPH
• Amar Parikh, M.D.
• Park Village Dental Group
• Anny Park, MSN, APRN, FNP-C
• Chuel-Hong Park, D.C. B.C.A.O
• Hojun Park, OMD
• Hyun Ho Park
• Hyung J Park, DC
• Irene Park, PHARMD

• Family Nurse Practitioner in Duluth, GA
• Providers in Duluth, GA by specialty
• Family Nurse Practitioner in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 13, 2017; 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.