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General NPI Number Information
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NPI Number | 1598610560
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Entity Type | Organization
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Legal Business Name | PEDS2PSYCH NP NURSING CORPORATION
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Dates
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Enumeration Date | 03/03/2026
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Last Update Date | 03/03/2026
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Provider Practice Location Address
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Address Line | 104 W MENDOCINO AVE
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City | WILLITS
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State | CA
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Zip | 95490-3412
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Country | US
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Telephone | 707-200-8194
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Fax | 651-666-1551
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Provider Business Mailing Address
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Address Line | 422 LARKFIELD CTR # 492
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City | SANTA ROSA
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State | CA
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Zip | 95403-1408
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Country | US
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Telephone | 707-200-8194
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Fax | 651-666-1551
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Authorized Official
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Title or Position | OWNER/NURSE PRACTITIONER
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Name | MEDIE JESENA PARROTT
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Credential | MSN, MPH
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Telephone | 707-200-8194
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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