Healthcare Provider Details

I. General information

NPI: 1033198056
Provider Name (Legal Business Name): DR. KAREN ANN PERRY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/10/2006
Last Update Date: 01/13/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1690 POLK 67
MENA AR
71953-7715
US

IV. Provider business mailing address

300 CRESTWOOD CIR
MENA AR
71953-5515
US

V. Phone/Fax

Practice location:
  • Phone: 479-394-1600
  • Fax: 479-394-1606
Mailing address:
  • Phone: 479-394-1600
  • Fax: 479-394-1606

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberN7848
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: