Individual
KAYLIE MARIE PARRISH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
324 4TH ST, MYRTLE POINT, OR 97458-1066
(541) 572-2111
(541) 572-5743
Mailing address
324 4TH ST, MYRTLE POINT, OR 97458-1066
(541) 572-2111
(541) 572-5743
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA159136
OR
363AM0700X
Medical Physician Assistant
PA159136
OR
363AS0400X
Surgical Physician Assistant
PA159136
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1407812365
GROUP NPI-NORTH BEND MEDICAL CENTER
OR
01
—
161133
GROUP MEDICAID-NORTH BEND MEDICAL CENTER
OR
01
—
930635514
GROUP TAX ID FOR BILLING - NORTH BEND MEDICAL CENTER
OR
01
—
R0000WFBTV
GROUP MEDICARE NUMBER-NORTH BEND MEDICAL CENTER
OR
Enumeration date
01/13/2011
Last updated
11/06/2012
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