Provider Demographics
NPI:1316386998
Name:PARISH-LARSON, KELLY KRISTINE (RN, CNP)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:KRISTINE
Last Name:PARISH-LARSON
Suffix:
Gender:F
Credentials:RN, CNP
Other - Prefix:
Other - First Name:KELLY
Other - Middle Name:KRISTINE
Other - Last Name:PARISH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3500 TOWER AVE
Mailing Address - Street 2:ESSENTIA HEALTH ST. MARY'S SUPERIOR CLINIC
Mailing Address - City:SUPERIOR
Mailing Address - State:WI
Mailing Address - Zip Code:54880-5335
Mailing Address - Country:US
Mailing Address - Phone:715-395-5454
Mailing Address - Fax:
Practice Address - Street 1:3500 TOWER AVE
Practice Address - Street 2:ESSENTIA HEALTH ST. MARY'S SUPERIOR CLINIC
Practice Address - City:SUPERIOR
Practice Address - State:WI
Practice Address - Zip Code:54880-5335
Practice Address - Country:US
Practice Address - Phone:715-395-5454
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-18
Last Update Date:2020-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI193379-30363LF0000X
WI5377-33363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1316386998Medicaid
WI1316386998Medicaid