Provider Demographics
NPI:1588124556
Name:PEERY, ADRIENNE MICHELLE (NP)
Entity type:Individual
Prefix:
First Name:ADRIENNE
Middle Name:MICHELLE
Last Name:PEERY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:ADRIENNE
Other - Middle Name:MICHELLE
Other - Last Name:JUDE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:6920 POINTE INVERNESS WAY STE 200
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46804-7934
Mailing Address - Country:US
Mailing Address - Phone:260-479-3514
Mailing Address - Fax:260-479-3520
Practice Address - Street 1:7910 W JEFFERSON BLVD STE 120
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46804-4159
Practice Address - Country:US
Practice Address - Phone:260-479-3514
Practice Address - Fax:260-479-3520
Is Sole Proprietor?:No
Enumeration Date:2019-03-25
Last Update Date:2024-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71013607A363LF0000X
KY3013057363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily