Provider Demographics
NPI:1285447110
Name:PERERA, JUSTINA NICOLE (PMHNP-BC)
Entity type:Individual
Prefix:
First Name:JUSTINA
Middle Name:NICOLE
Last Name:PERERA
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:JUSTINA
Other - Middle Name:NICOLE
Other - Last Name:KRATKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:600 4TH ST STE 501
Mailing Address - Street 2:
Mailing Address - City:SIOUX CITY
Mailing Address - State:IA
Mailing Address - Zip Code:51101-1606
Mailing Address - Country:US
Mailing Address - Phone:712-234-0220
Mailing Address - Fax:
Practice Address - Street 1:600 4TH ST STE 501
Practice Address - Street 2:
Practice Address - City:SIOUX CITY
Practice Address - State:IA
Practice Address - Zip Code:51101-1606
Practice Address - Country:US
Practice Address - Phone:712-234-0220
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-27
Last Update Date:2025-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAG182822363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health