Healthcare Provider Details

I. General information

NPI: 1831916295
Provider Name (Legal Business Name): JONATHAN REESE PARROTT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/25/2024
Last Update Date: 06/19/2026
Certification Date: 06/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

929 N SAINT FRANCIS AVE
WICHITA KS
67214-3821
US

IV. Provider business mailing address

1010 N KANSAS ST
WICHITA KS
67214-3124
US

V. Phone/Fax

Practice location:
  • Phone: 316-858-3548
  • Fax:
Mailing address:
  • Phone: 316-293-2635
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number94-12776
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: