Provider Demographics
NPI:1174056402
Name:PARSONS, KAYLEE RAE (DO)
Entity type:Individual
Prefix:
First Name:KAYLEE
Middle Name:RAE
Last Name:PARSONS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:KAYLEE
Other - Middle Name:RAE
Other - Last Name:KENYON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:11234 ANDERSON ST
Mailing Address - Street 2:GME OFFICE WESTERLY SUITE 'C'
Mailing Address - City:LOMA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92354-2804
Mailing Address - Country:US
Mailing Address - Phone:909-558-4174
Mailing Address - Fax:
Practice Address - Street 1:12665 GARDEN GROVE BLVD STE 713
Practice Address - Street 2:
Practice Address - City:GARDEN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92843-1921
Practice Address - Country:US
Practice Address - Phone:714-542-1331
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-04
Last Update Date:2020-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A16740208000000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics