Provider Demographics
NPI:1336609114
Name:PERRY, MARYANN
Entity type:Individual
Prefix:
First Name:MARYANN
Middle Name:
Last Name:PERRY
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 1:459 KY 930
Mailing Address - Street 2:
Mailing Address - City:ARTEMUS
Mailing Address - State:KY
Mailing Address - Zip Code:40903-6015
Mailing Address - Country:US
Mailing Address - Phone:606-622-1230
Mailing Address - Fax:
Practice Address - Street 1:459 KY 930
Practice Address - Street 2:
Practice Address - City:ARTEMUS
Practice Address - State:KY
Practice Address - Zip Code:40903-6015
Practice Address - Country:US
Practice Address - Phone:606-622-1230
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-20
Last Update Date:2019-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3013215363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily