Provider Demographics
NPI:1750671699
Name:PARRY, KIRK D (BS)
Entity Type:Individual
Prefix:MR
First Name:KIRK
Middle Name:D
Last Name:PARRY
Suffix:
Gender:M
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:521 W LOTT ST
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:WY
Mailing Address - Zip Code:82834-1642
Mailing Address - Country:US
Mailing Address - Phone:307-684-5531
Mailing Address - Fax:307-684-2912
Practice Address - Street 1:521 W LOTT ST
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:WY
Practice Address - Zip Code:82834-1642
Practice Address - Country:US
Practice Address - Phone:307-684-5531
Practice Address - Fax:307-684-2912
Is Sole Proprietor?:No
Enumeration Date:2011-04-12
Last Update Date:2016-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY171M00000X, 172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No172V00000XOther Service ProvidersCommunity Health Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY130822000Medicaid