Basic Information
| Provider Information | |||||||||
| NPI: | 1043262223 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PARSLEY | ||||||||
| FirstName: | DEIDRE | ||||||||
| MiddleName: | E | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | DO | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | |||||||||
| OtherFirstName: | |||||||||
| OtherMiddleName: | |||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | |||||||||
| OtherLastNameType: | |||||||||
| Mailing Information | |||||||||
| Address1: | PO BOX 1958 | ||||||||
| Address2: | |||||||||
| City: | WILLIAMSON | ||||||||
| State: | WV | ||||||||
| PostalCode: | 256611958 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3042352930 | ||||||||
| FaxNumber: | 3042352933 | ||||||||
| Practice Location | |||||||||
| Address1: | 2900 FIRST AVENUE | ||||||||
| Address2: | |||||||||
| City: | HUNTINGTON | ||||||||
| State: | WV | ||||||||
| PostalCode: | 25702 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3043997484 | ||||||||
| FaxNumber: | 3043997579 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/16/2006 | ||||||||
| LastUpdateDate: | 05/15/2009 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | |||||||||
| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | |||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 2060 | WV | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 107376 | 01 | WV | BRICKSTREET | OTHER | 3810000626 | 05 | WV | MEDICAID | 7800765 | 01 | WV | CIGNA | OTHER | 2177885 | 01 | WV | UHC | OTHER | 000000245867 | 01 | OH | UNISON | OTHER | 64065246 | 05 | KY | MEDICAID |