Provider Demographics
NPI:1295784080
Name:PARSONS, JACK NEIL (CRNA)
Entity type:Individual
Prefix:MR
First Name:JACK
Middle Name:NEIL
Last Name:PARSONS
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 RAVEN HILL DRIVE
Mailing Address - Street 2:
Mailing Address - City:ATCHISON
Mailing Address - State:KS
Mailing Address - Zip Code:66002
Mailing Address - Country:US
Mailing Address - Phone:913-367-2131
Mailing Address - Fax:913-674-2023
Practice Address - Street 1:800 RAVEN HILL DRIVE
Practice Address - Street 2:
Practice Address - City:ATCHISON
Practice Address - State:KS
Practice Address - Zip Code:66002
Practice Address - Country:US
Practice Address - Phone:913-367-2131
Practice Address - Fax:913-674-2023
Is Sole Proprietor?:No
Enumeration Date:2006-05-09
Last Update Date:2016-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1340229031174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS9159788101Medicaid
KS430000141OtherRR MEDICARE
KS430000141OtherRR MEDICARE