Provider Demographics
NPI:1992714505
Name:PARNELL, KATHY SUE
Entity type:Individual
Prefix:DR
First Name:KATHY
Middle Name:SUE
Last Name:PARNELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:505 W PERSHING BLVD STE C
Mailing Address - Street 2:
Mailing Address - City:NORTH LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72114-2157
Mailing Address - Country:US
Mailing Address - Phone:501-758-7352
Mailing Address - Fax:501-771-5014
Practice Address - Street 1:505 W PERSHING BLVD STE C
Practice Address - Street 2:
Practice Address - City:NORTH LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72114-2157
Practice Address - Country:US
Practice Address - Phone:501-758-7352
Practice Address - Fax:501-771-5014
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2008-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE2349207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR142106001Medicaid
ARH14903Medicare UPIN
AR142106001Medicaid
AR5L479Medicare PIN