Healthcare Provider Details

I. General information

NPI: 1831475698
Provider Name (Legal Business Name): VANESSA MARIE PERRY RN, PNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/25/2011
Last Update Date: 09/21/2026
Certification Date: 09/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1235 EAST BLVD STE E
CHARLOTTE NC
28203-5876
US

IV. Provider business mailing address

PO BOX 143
PAW CREEK NC
28130-0143
US

V. Phone/Fax

Practice location:
  • Phone: 980-531-6136
  • Fax:
Mailing address:
  • Phone: 585-355-9192
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number636479
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number330796
License Number StateNC
# 3
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number5019933
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: