MEDICARE: TABETHA J PERRY MSN, FNP-BC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	271528	SC
2	363LF0000X	Family Nurse Practitioner	333582	AZ

General Provider Information

NPI Number	:	1114888559
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TABETHA J PERRY MSN, FNP-BC

Provider Business Mailing Address
First Line	:	409 S LENZNER AVE APT 4202
Second Line	:
City	:	SIERRA VISTA
State	:	AZ
Zip	:	85635-5637
Country	:	US
Telephone Number	:	423-502-1072
Fax Number	:

Provider Business Practice Location Address
First Line	:	2250 EL MERCADO LOOP
Second Line	:
City	:	SIERRA VISTA
State	:	AZ
Zip	:	85635-5204
Country	:	US
Telephone Number	:	520-220-5020
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/24/2025
Last Update Date	:	03/16/2026

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