Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | A005539 | AR |
NPI | 1003302639 |
---|---|
Provider Name | Mrs. Michelle Parish |
First Address | Little Rock, AR 72205-3328 |
Second Address | Little Rock, AR 72205 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/07/2018 |
Last Update Date | 23/07/2018 |