Provider Demographics
NPI:1871596858
Name:PARSONS, JERRY M (PAC/ATC)
Entity type:Individual
Prefix:MR
First Name:JERRY
Middle Name:M
Last Name:PARSONS
Suffix:
Gender:M
Credentials:PAC/ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 W PICKWICK DR
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:IN
Mailing Address - Zip Code:46567-1832
Mailing Address - Country:US
Mailing Address - Phone:574-457-8585
Mailing Address - Fax:260-479-2913
Practice Address - Street 1:107 W PICKWICK DR
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:IN
Practice Address - Zip Code:46567-1832
Practice Address - Country:US
Practice Address - Phone:574-457-8585
Practice Address - Fax:260-479-2913
Is Sole Proprietor?:No
Enumeration Date:2005-05-24
Last Update Date:2021-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN10000250A363A00000X
IN10000250363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
INS13684Medicare UPIN
IN132560XMedicare ID - Type Unspecified