Provider Demographics
NPI:1558025148
Name:PARSONS, COREY DEWAYNE
Entity Type:Individual
Prefix:
First Name:COREY
Middle Name:DEWAYNE
Last Name:PARSONS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5123 WAYCROSS DR
Mailing Address - Street 2:
Mailing Address - City:CROSS LANES
Mailing Address - State:WV
Mailing Address - Zip Code:25313-1719
Mailing Address - Country:US
Mailing Address - Phone:304-881-8806
Mailing Address - Fax:
Practice Address - Street 1:5123 WAYCROSS DR
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25313-1719
Practice Address - Country:US
Practice Address - Phone:304-881-8806
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-28
Last Update Date:2021-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program