Provider Demographics
NPI:1275568628
Name:EDWARDS-PARRISH, PATRICIA (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:DR
First Name:PATRICIA
Middle Name:
Last Name:EDWARDS-PARRISH
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4000 JENNINGS STATION RD
Mailing Address - Street 2:3923 SUNNYVALE CT
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63121-3323
Mailing Address - Country:US
Mailing Address - Phone:314-679-7800
Mailing Address - Fax:
Practice Address - Street 1:4000 JENNINGS STATION RD
Practice Address - Street 2:3923 SUNNYVALE CT
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63121-3323
Practice Address - Country:US
Practice Address - Phone:314-679-7800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-12
Last Update Date:2014-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO079333363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1275568628Medicaid
MO831400753Medicare PIN