Provider Demographics
NPI:1962221960
Name:PARRY, KYLE
Entity type:Individual
Prefix:
First Name:KYLE
Middle Name:
Last Name:PARRY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:475 W PRICE RIVER DR STE 152
Mailing Address - Street 2:
Mailing Address - City:PRICE
Mailing Address - State:UT
Mailing Address - Zip Code:84501-2859
Mailing Address - Country:US
Mailing Address - Phone:435-630-1303
Mailing Address - Fax:
Practice Address - Street 1:475 W PRICE RIVER DR STE 152
Practice Address - Street 2:
Practice Address - City:PRICE
Practice Address - State:UT
Practice Address - Zip Code:84501-2859
Practice Address - Country:US
Practice Address - Phone:435-630-1303
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-07
Last Update Date:2024-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP0905XAmbulatory Health Care FacilitiesClinic/CenterPublic Health, State or Local