Provider Demographics
NPI:1154626679
Name:PARRISH, KAYLIE MARIE
Entity Type:Individual
Prefix:
First Name:KAYLIE
Middle Name:MARIE
Last Name:PARRISH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KAYLIE
Other - Middle Name:MARIE
Other - Last Name:TOWNE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:324 4TH ST
Mailing Address - Street 2:
Mailing Address - City:MYRTLE POINT
Mailing Address - State:OR
Mailing Address - Zip Code:97458-1066
Mailing Address - Country:US
Mailing Address - Phone:541-572-2111
Mailing Address - Fax:541-572-5743
Practice Address - Street 1:324 4TH ST
Practice Address - Street 2:
Practice Address - City:MYRTLE POINT
Practice Address - State:OR
Practice Address - Zip Code:97458-1066
Practice Address - Country:US
Practice Address - Phone:541-572-2111
Practice Address - Fax:541-572-5743
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-13
Last Update Date:2012-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORPA159136363A00000X, 363AM0700X, 363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR161133OtherGROUP MEDICAID-NORTH BEND MEDICAL CENTER
OR930635514OtherGROUP TAX ID FOR BILLING - NORTH BEND MEDICAL CENTER
OR1407812365OtherGROUP NPI-NORTH BEND MEDICAL CENTER
ORR0000WFBTVOtherGROUP MEDICARE NUMBER-NORTH BEND MEDICAL CENTER