Healthcare Provider Details

I. General information

NPI: 1114752177
Provider Name (Legal Business Name): TIFFANY MARIE PERRY CD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/07/2024
Last Update Date: 08/22/2025
Certification Date: 08/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1025 RIVERSTONE RD TRLR 8
FARMINGTON NM
87401-2881
US

IV. Provider business mailing address

1025 RIVERSTONE RD TRLR 8
FARMINGTON NM
87401-2881
US

V. Phone/Fax

Practice location:
  • Phone: 505-716-2227
  • Fax:
Mailing address:
  • Phone: 505-716-2227
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174N00000X
TaxonomyLactation Consultant (Non-RN)
License Number85446
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: