Provider Demographics
NPI:1992254486
Name:PERRY, BRIAN (APRN)
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:
Last Name:PERRY
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1905 CHATEAU BLVD
Mailing Address - Street 2:
Mailing Address - City:PARAGOULD
Mailing Address - State:AR
Mailing Address - Zip Code:72450-6279
Mailing Address - Country:US
Mailing Address - Phone:870-236-2265
Mailing Address - Fax:870-215-0772
Practice Address - Street 1:1905 CHATEAU BLVD
Practice Address - Street 2:
Practice Address - City:PARAGOULD
Practice Address - State:AR
Practice Address - Zip Code:72450-6279
Practice Address - Country:US
Practice Address - Phone:870-236-2265
Practice Address - Fax:870-215-0772
Is Sole Proprietor?:No
Enumeration Date:2016-09-26
Last Update Date:2025-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA004901363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner