Healthcare Provider Details

I. General information

NPI: 1184807075
Provider Name (Legal Business Name): KIMBERLEE J PARROTT DENTAL HYGIENIST
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/13/2007
Last Update Date: 12/13/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

331 SIJEN AVE
WHITEMAN AFB MO
65305-1269
US

IV. Provider business mailing address

331 SIJEN AVE
WHITEMAN AFB MO
65305-1269
US

V. Phone/Fax

Practice location:
  • Phone: 660-687-2201
  • Fax: 660-687-1862
Mailing address:
  • Phone: 660-687-2201
  • Fax: 660-687-1862

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number2005015655
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: