Healthcare Provider Details

I. General information

NPI: 1265780340
Provider Name (Legal Business Name): PARRISH EDWARD HARLESS APRN, FNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/21/2012
Last Update Date: 06/14/2023
Certification Date: 06/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4602 MACCORKLE AVE SE
CHARLESTON WV
25304-1848
US

IV. Provider business mailing address

104 ALEX LN
CHARLESTON WV
25304-2952
US

V. Phone/Fax

Practice location:
  • Phone: 304-205-7535
  • Fax: 304-205-7539
Mailing address:
  • Phone: 304-734-2040
  • Fax: 304-734-2047

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number73133
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: