Provider Demographics
NPI:1902404759
Name:PARR, CASSIE (APRN)
Entity Type:Individual
Prefix:
First Name:CASSIE
Middle Name:
Last Name:PARR
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:57 MELISSA BRANCH RD
Mailing Address - Street 2:
Mailing Address - City:ARY
Mailing Address - State:KY
Mailing Address - Zip Code:41712-8716
Mailing Address - Country:US
Mailing Address - Phone:606-233-4692
Mailing Address - Fax:
Practice Address - Street 1:57 MELISSA BRANCH RD
Practice Address - Street 2:
Practice Address - City:ARY
Practice Address - State:KY
Practice Address - Zip Code:41712-8716
Practice Address - Country:US
Practice Address - Phone:606-233-4692
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-14
Last Update Date:2020-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3014121363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY3014121OtherKENTUCKY APRN LICENSE NUMBER