Provider Demographics
NPI:1881622751
Name:PARISH, KYLE DOUGLAS (MD)
Entity type:Individual
Prefix:
First Name:KYLE
Middle Name:DOUGLAS
Last Name:PARISH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:1532 LONE OAK RD
Mailing Address - Street 2:STE. 305
Mailing Address - City:PADUCAH
Mailing Address - State:KY
Mailing Address - Zip Code:42003-7913
Mailing Address - Country:US
Mailing Address - Phone:270-443-0010
Mailing Address - Fax:270-538-5622
Practice Address - Street 1:1532 LONE OAK RD
Practice Address - Street 2:STE. 305
Practice Address - City:PADUCAH
Practice Address - State:KY
Practice Address - Zip Code:42003-7913
Practice Address - Country:US
Practice Address - Phone:270-443-0010
Practice Address - Fax:270-538-5622
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2017-04-20
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
KY38909207Q00000X, 207QA0000X, 207QA0401X, 207QA0505X, 207QG0300X, 207QS0010X, 207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QA0000XAllopathic & Osteopathic PhysiciansFamily MedicineAdolescent Medicine
No207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction Medicine
No207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
No207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
No207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64107030Medicaid
KY64107030Medicaid
KYI39734Medicare UPIN