Provider Demographics
NPI:1447449350
Name:KYLE D PARISH MD PSC
Entity type:Organization
Organization Name:KYLE D PARISH MD PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TIFFANY
Authorized Official - Middle Name:BROOKE
Authorized Official - Last Name:GREAM
Authorized Official - Suffix:
Authorized Official - Credentials:LPN
Authorized Official - Phone:270-443-0010
Mailing Address - Street 1:2407 NEW HOLT RD
Mailing Address - Street 2:
Mailing Address - City:PADUCAH
Mailing Address - State:KY
Mailing Address - Zip Code:42001-7455
Mailing Address - Country:US
Mailing Address - Phone:270-443-0010
Mailing Address - Fax:270-558-1492
Practice Address - Street 1:2407 NEW HOLT RD
Practice Address - Street 2:
Practice Address - City:PADUCAH
Practice Address - State:KY
Practice Address - Zip Code:42001-7455
Practice Address - Country:US
Practice Address - Phone:270-443-0010
Practice Address - Fax:270-558-1492
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-16
Last Update Date:2025-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY38909207QS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports MedicineGroup - Single Specialty