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General NPI Number Information
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NPI Number | 1154626679
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Entity Type | Individual
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Provider Name | KAYLIE MARIE PARRISH
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Gender | Female
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Dates
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Enumeration Date | 01/13/2011
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Last Update Date | 11/06/2012
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Provider Practice Location Address
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Address Line | 324 4TH ST
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City | MYRTLE POINT
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State | OR
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Zip | 97458-1066
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Country | US
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Telephone | 541-572-2111
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Fax | 541-572-5743
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Provider Business Mailing Address
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Address Line | 324 4TH ST
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City | MYRTLE POINT
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State | OR
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Zip | 97458-1066
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Country | US
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Telephone | 541-572-2111
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Fax | 541-572-5743
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA159136
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License Number State | OR
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Taxonomy #2
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | PA159136
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License Number State | OR
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Taxonomy #3
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | PA159136
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License Number State | OR
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