Healthcare Provider Details

I. General information

NPI: 1194279976
Provider Name (Legal Business Name): PAMELA L PERRY PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/09/2016
Last Update Date: 08/12/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14301 N 87TH ST STE 315
SCOTTSDALE AZ
85260-3692
US

IV. Provider business mailing address

14301 N 87TH ST STE 315
SCOTTSDALE AZ
85260-3692
US

V. Phone/Fax

Practice location:
  • Phone: 480-818-0125
  • Fax:
Mailing address:
  • Phone: 480-818-0125
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAP8886
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: