Healthcare Provider Details

I. General information

NPI: 1114763588
Provider Name (Legal Business Name): MRS. AMY LEIGH PERKEY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/05/2024
Last Update Date: 09/04/2024
Certification Date: 09/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3850 E STATE ROAD 64
BRADENTON FL
34208-9040
US

IV. Provider business mailing address

1367 RIO DE JANEIRO AVE
PUNTA GORDA FL
33983-6213
US

V. Phone/Fax

Practice location:
  • Phone: 941-748-2697
  • Fax:
Mailing address:
  • Phone: 405-618-6902
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: