Provider Demographics
NPI:1902880222
Name:PARKS, CHERYL ROSE (CRNA)
Entity Type:Individual
Prefix:
First Name:CHERYL
Middle Name:ROSE
Last Name:PARKS
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 790058
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63179-0058
Mailing Address - Country:US
Mailing Address - Phone:636-549-2380
Mailing Address - Fax:314-569-5974
Practice Address - Street 1:45 THOMAS JOHNSON DR
Practice Address - Street 2:SUITE 207
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21702-4425
Practice Address - Country:US
Practice Address - Phone:301-694-3400
Practice Address - Fax:301-694-3620
Is Sole Proprietor?:No
Enumeration Date:2005-11-30
Last Update Date:2010-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDRO68640364S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364S00000XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDP00137653OtherMEDICARE RAILROAD (PTAN CJ8689)
MDP00687678OtherMEDICARE RAILROAD (PTAN DD6120)
DCS417-0007OtherCAREFIRST BCBS
MDKBC1CHOtherCAREFIRST BCBS
MDP00687678OtherMEDICARE RAILROAD (PTAN DD6120)