Healthcare Provider Details

I. General information

NPI: 1881622751
Provider Name (Legal Business Name): KYLE DOUGLAS PARISH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2006
Last Update Date: 08/13/2025
Certification Date: 08/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2407 NEW HOLT RD
PADUCAH KY
42001-7455
US

IV. Provider business mailing address

2407 NEW HOLT RD
PADUCAH KY
42001-7455
US

V. Phone/Fax

Practice location:
  • Phone: 270-443-0010
  • Fax: 270-558-1492
Mailing address:
  • Phone: 270-443-0010
  • Fax: 270-558-1492

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number38909
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code207QA0000X
TaxonomyAdolescent Medicine (Family Medicine) Physician
License Number38909
License Number StateKY
# 3
Primary TaxonomyN
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number38909
License Number StateKY
# 4
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number38909
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: