Provider Demographics
NPI:1194279976
Name:PERRY, PAMELA L (PMHNP)
Entity type:Individual
Prefix:MS
First Name:PAMELA
Middle Name:L
Last Name:PERRY
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14301 N 87TH ST STE 315
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85260-3692
Mailing Address - Country:US
Mailing Address - Phone:480-818-0125
Mailing Address - Fax:
Practice Address - Street 1:14301 N 87TH ST STE 315
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85260-3692
Practice Address - Country:US
Practice Address - Phone:480-818-0125
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-09
Last Update Date:2016-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP8886363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health