Provider Demographics
NPI:1376790998
Name:PARROTT-ALLEN, MARY JUSTINE
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:JUSTINE
Last Name:PARROTT-ALLEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1320 E BROADWAY ST STE A
Mailing Address - Street 2:
Mailing Address - City:CAMPBELLSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42718-1596
Mailing Address - Country:US
Mailing Address - Phone:270-849-7207
Mailing Address - Fax:270-592-0402
Practice Address - Street 1:1320 E BROADWAY ST STE A
Practice Address - Street 2:
Practice Address - City:CAMPBELLSVILLE
Practice Address - State:KY
Practice Address - Zip Code:42718-1596
Practice Address - Country:US
Practice Address - Phone:270-849-7207
Practice Address - Fax:270-465-0575
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-26
Last Update Date:2021-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY2163781744P3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY0000000578817OtherANTHEM BLUE CROSS BLUE SHIELD
KY6135710001Medicare NSC