Provider Demographics
NPI:1518128180
Name:PARRISH, TRACY LYNN (MD)
Entity Type:Individual
Prefix:
First Name:TRACY
Middle Name:LYNN
Last Name:PARRISH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:902 KIRKWOOD AVE NW
Mailing Address - Street 2:
Mailing Address - City:LENOIR
Mailing Address - State:NC
Mailing Address - Zip Code:28645-5121
Mailing Address - Country:US
Mailing Address - Phone:828-754-0101
Mailing Address - Fax:828-757-0402
Practice Address - Street 1:902 KIRKWOOD AVE NW
Practice Address - Street 2:
Practice Address - City:LENOIR
Practice Address - State:NC
Practice Address - Zip Code:28645-5121
Practice Address - Country:US
Practice Address - Phone:828-754-0101
Practice Address - Fax:828-757-0402
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-17
Last Update Date:2024-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2010-00398207PH0002X, 207Q00000X, 207P00000X
NC149358390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207PH0002XAllopathic & Osteopathic PhysiciansEmergency MedicineHospice and Palliative Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCNC0328AMedicare PIN