Provider Demographics
NPI:1992821755
Name:PERRY, PATRICIA R (APRN)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:R
Last Name:PERRY
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3520 AVENUE I
Mailing Address - Street 2:
Mailing Address - City:KEARNEY
Mailing Address - State:NE
Mailing Address - Zip Code:68847-3213
Mailing Address - Country:US
Mailing Address - Phone:308-234-5651
Mailing Address - Fax:
Practice Address - Street 1:2337 N WEBB RD
Practice Address - Street 2:
Practice Address - City:GRAND ISLAND
Practice Address - State:NE
Practice Address - Zip Code:68803-1743
Practice Address - Country:US
Practice Address - Phone:308-384-7625
Practice Address - Fax:308-384-8904
Is Sole Proprietor?:No
Enumeration Date:2007-03-22
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE110556363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE239940OtherMIDLANDS PROVIDER #
NE38362OtherBCBS PROVIDER #
NE239940OtherMIDLANDS PROVIDER #
NE276668Medicare ID - Type UnspecifiedPROVIDER #