Provider Demographics
NPI:1487609491
Name:PARISH, KATHY SUE (ANP)
Entity type:Individual
Prefix:MRS
First Name:KATHY
Middle Name:SUE
Last Name:PARISH
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:KATHY
Other - Middle Name:SUE
Other - Last Name:ROBERSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:711 SANTA FE DR
Mailing Address - Street 2:HEART CLINIC ARKANSAS
Mailing Address - City:SEARCY
Mailing Address - State:AR
Mailing Address - Zip Code:72143-6964
Mailing Address - Country:US
Mailing Address - Phone:501-281-0850
Mailing Address - Fax:501-279-9073
Practice Address - Street 1:711 SANTA FE DR
Practice Address - Street 2:HEART CLINIC ARKANSAS
Practice Address - City:SEARCY
Practice Address - State:AR
Practice Address - Zip Code:72143-6964
Practice Address - Country:US
Practice Address - Phone:501-281-0850
Practice Address - Fax:501-279-9073
Is Sole Proprietor?:No
Enumeration Date:2006-05-24
Last Update Date:2011-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR19319163W00000X
ARA01158363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR104541001Medicaid
AR104541001Medicaid
S41431Medicare UPIN