Provider Demographics
NPI:1851684674
Name:PERRY, JENNINGS MICHAEL (DNP)
Entity type:Individual
Prefix:
First Name:JENNINGS
Middle Name:MICHAEL
Last Name:PERRY
Suffix:
Gender:
Credentials:DNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:728 CONIFER CT
Mailing Address - Street 2:
Mailing Address - City:MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29572-4172
Mailing Address - Country:US
Mailing Address - Phone:614-203-3515
Mailing Address - Fax:
Practice Address - Street 1:1301 48TH AVE N # A-2
Practice Address - Street 2:
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29577-5427
Practice Address - Country:US
Practice Address - Phone:843-855-2299
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-26
Last Update Date:2025-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH353367163W00000X
OH17756363LF0000X
SC20499363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No163W00000XNursing Service ProvidersRegistered Nurse
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily