Healthcare Provider Details

I. General information

NPI: 1942624051
Provider Name (Legal Business Name): KYLE PARISH CPM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KYLE K PARISH CPM

II. Dates (important events)

Enumeration Date: 02/10/2014
Last Update Date: 03/09/2020
Certification Date: 03/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3227 N CROMWELL DR
WICHITA KS
67204-4447
US

IV. Provider business mailing address

1130 S CLIFTON AVE
WICHITA KS
67218-2913
US

V. Phone/Fax

Practice location:
  • Phone: 316-209-3559
  • Fax: 316-803-1562
Mailing address:
  • Phone: 316-803-1562
  • Fax: 316-803-1562

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License Number18110002
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: