Healthcare Provider Details

I. General information

NPI: 1750671699
Provider Name (Legal Business Name): KIRK D PARRY B.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/12/2011
Last Update Date: 03/23/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

521 W LOTT ST
BUFFALO WY
82834-1642
US

IV. Provider business mailing address

521 W LOTT ST
BUFFALO WY
82834-1642
US

V. Phone/Fax

Practice location:
  • Phone: 307-684-5531
  • Fax: 307-684-2912
Mailing address:
  • Phone: 307-684-5531
  • Fax: 307-684-2912

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateWY
# 2
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: