Provider Demographics
NPI:1912495102
Name:PARRISH, JENNIFER JEAN (MED)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:JEAN
Last Name:PARRISH
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3132 OLD CLARKSVILLE SPGFLD RD
Mailing Address - Street 2:
Mailing Address - City:ADAMS
Mailing Address - State:TN
Mailing Address - Zip Code:37010-8907
Mailing Address - Country:US
Mailing Address - Phone:301-752-6997
Mailing Address - Fax:
Practice Address - Street 1:3132 OLD CLARKSVILLE SPGFLD RD
Practice Address - Street 2:
Practice Address - City:ADAMS
Practice Address - State:TN
Practice Address - Zip Code:37010
Practice Address - Country:US
Practice Address - Phone:301-752-6997
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-24
Last Update Date:2018-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN127103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst