Healthcare Provider Details

I. General information

NPI: 1124755582
Provider Name (Legal Business Name): BRENDA A PERKEY NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: BRENDA CUNNINGHAM RN

II. Dates (important events)

Enumeration Date: 08/05/2022
Last Update Date: 10/04/2022
Certification Date: 10/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4880 CENTURY PLAZA RD STE 165
INDIANAPOLIS IN
46254-5475
US

IV. Provider business mailing address

250 N SHADELAND AVE
INDIANAPOLIS IN
46219-4959
US

V. Phone/Fax

Practice location:
  • Phone: 317-843-0000
  • Fax: 317-968-1183
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number71012777A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number71012777A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: