Provider Demographics
NPI:1417498635
Name:PRUSICK, PARKER (MD)
Entity Type:Individual
Prefix:
First Name:PARKER
Middle Name:
Last Name:PRUSICK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 E MAXWELL ST STE 201
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40508-2678
Mailing Address - Country:US
Mailing Address - Phone:859-323-5533
Mailing Address - Fax:859-257-2816
Practice Address - Street 1:125 E MAXWELL ST STE 201
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40508-2678
Practice Address - Country:US
Practice Address - Phone:859-323-5533
Practice Address - Fax:859-257-2816
Is Sole Proprietor?:No
Enumeration Date:2017-03-20
Last Update Date:2023-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYTP653207X00000X, 207XS0117X
KY58462207X00000X, 207XS0117X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the Spine
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program