Healthcare Provider Details

I. General information

NPI: 1295784080
Provider Name (Legal Business Name): JACK NEIL PARSONS CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/09/2006
Last Update Date: 04/04/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 RAVEN HILL DRIVE
ATCHISON KS
66002
US

IV. Provider business mailing address

800 RAVEN HILL DRIVE
ATCHISON KS
66002
US

V. Phone/Fax

Practice location:
  • Phone: 913-367-2131
  • Fax: 913-674-2023
Mailing address:
  • Phone: 913-367-2131
  • Fax: 913-674-2023

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number1340229031
License Number StateKS

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier9159788101
Identifier TypeMEDICAID
Identifier StateKS
Identifier Issuer
# 2
Identifier430000141
Identifier TypeOTHER
Identifier StateKS
Identifier IssuerRR MEDICARE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: