Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TH0100X | Health Service |
NPI | 1316532419 |
---|---|
Provider Name | Talisha Parks |
First Address | Logansport, LA 71049-2914 |
Second Address | Logansport, LA 71049-2914 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/03/2021 |
Last Update Date | 02/03/2021 |