Healthcare Provider Details

I. General information

NPI: 1598930059
Provider Name (Legal Business Name): MEDIE JESENA PARROTT MSN, MPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MEDIE ALITA JESENA

II. Dates (important events)

Enumeration Date: 04/25/2008
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

422 LARKFIELD CTR # 492
SANTA ROSA CA
95403-1408
US

IV. Provider business mailing address

422 LARKFIELD CTR # 492
SANTA ROSA CA
95403-1408
US

V. Phone/Fax

Practice location:
  • Phone: 707-370-8774
  • Fax: 651-666-1551
Mailing address:
  • Phone: 707-370-8774
  • Fax: 651-666-1551

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number15259
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number15259
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number15259
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberNP15259
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: