Healthcare Provider Details

I. General information

NPI: 1659938835
Provider Name (Legal Business Name): PHILIP EDWARD PARROTT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2019
Last Update Date: 05/23/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1974 WALTON NICHOLSON PIKE
INDEPENDENCE KY
41051-7906
US

IV. Provider business mailing address

1974 WALTON NICHOLSON PIKE
INDEPENDENCE KY
41051-7906
US

V. Phone/Fax

Practice location:
  • Phone: 859-359-5404
  • Fax:
Mailing address:
  • Phone: 859-359-5404
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code405300000X
TaxonomyPrevention Professional
License Number86000370A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: