Basic Information
Provider Information
NPI: 1902287501
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: PARRISH
FirstName: TIMOTHY
MiddleName:  
NamePrefix: MR.
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 406S 30TH AVE 202
Address2:  
City: YAKIMA
State: WA
PostalCode: 989023713
CountryCode: US
TelephoneNumber: 5099721051
FaxNumber: 5099724166
Practice Location
Address1: 27 RED DEER CV
Address2:  
City: JACKSON
State: TN
PostalCode: 383056485
CountryCode: US
TelephoneNumber: 7318031096
FaxNumber:  
Other Information
ProviderEnumerationDate: 06/09/2015
LastUpdateDate: 08/28/2015
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
367500000XAP60577902WAY Physician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered 

No ID Information.


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