Basic Information
| Provider Information | |||||||||
| NPI: | 1811180409 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PARSONS | ||||||||
| FirstName: | JEREMY | ||||||||
| MiddleName: | CRAIG | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 406 | ||||||||
| Address2: | |||||||||
| City: | PRESTONSBURG | ||||||||
| State: | KY | ||||||||
| PostalCode: | 416530406 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6064788787 | ||||||||
| FaxNumber: | 6064784801 | ||||||||
| Practice Location | |||||||||
| Address1: | 24 LEFT PENHOOK RD | ||||||||
| Address2: | |||||||||
| City: | HAROLD | ||||||||
| State: | KY | ||||||||
| PostalCode: | 416357064 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6064788787 | ||||||||
| FaxNumber: | 6064784801 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/27/2007 | ||||||||
| LastUpdateDate: | 09/25/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 42142 | KY | Y | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | TP164 | KY | N | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 7100055110 | 05 | KY | MEDICAID |