Ethan Parks, RN is a
Family Medicine physician based in Vancleave, Mississippi. Ethan Parks is licensed to practice in Mississippi (license number 925860) and his current practice location is 6312 Allen Rd, Vancleave, Mississippi. He can be reached at his office (for appointments etc.) via phone at
(228) 900-0797.
NPI number for Ethan Parks is 1518874718 and his current mailing address is 13323 John Clark Rd, Gulfport, Mississippi. He
does not participate in medicare program and thus does not accept medicare assignments. His NPI Number is 1518874718.
Physician's Profile
| Full Name | Ethan Parks |
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| Gender | Male |
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| Speciality | Family Medicine |
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| Location | 6312 Allen Rd, Vancleave, Mississippi |
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| Accepts Medicare Assignments | Does not participate in Medicare Program. He may not accept medicare assignment. |
NPI Data:
- NPI Number: 1518874718
- Provider Enumeration Date: 08/25/2026
- Last Update Date: 08/25/2026
Medical Identifiers
Medical identifiers for Ethan Parks such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
| 1518874718 | NPI | - | NPPES |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
| 207Q00000X | Family Medicine | 925860 (Mississippi) | Primary |
Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Ethan Parks is
NOT enrolled with medicare and thus cannot prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
| Mailing Address | Practice Location Address |
Ethan Parks, RN 13323 John Clark Rd, Gulfport, MS 39503-4846 Ph: (228) 669-9854 | Ethan Parks, RN 6312 Allen Rd, Vancleave, MS 39565-8643 Ph: (228) 900-0797 |
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