Provider Demographics
NPI:1710239728
Name:PARRIS, PRISCILLA TAYLOR (NP)
Entity Type:Individual
Prefix:MS
First Name:PRISCILLA
Middle Name:TAYLOR
Last Name:PARRIS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:PRISCILLA
Other - Middle Name:TAYLOR PARRIS
Other - Last Name:MCCORMACK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:50 STANIFORD STREET
Mailing Address - Street 2:SUITE 300
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02114-2542
Mailing Address - Country:US
Mailing Address - Phone:617-726-2000
Mailing Address - Fax:
Practice Address - Street 1:50 STANIFORD STREET
Practice Address - Street 2:SUITE 300
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114-2542
Practice Address - Country:US
Practice Address - Phone:617-726-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-15
Last Update Date:2014-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN273541363L00000X, 363LA2200X, 363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care