Healthcare Provider Details

I. General information

NPI: 1972013407
Provider Name (Legal Business Name): MICHELLE PERRY APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/11/2017
Last Update Date: 11/05/2025
Certification Date: 11/05/2025
Deactivation Date: 10/07/2024
Reactivation Date: 10/23/2024

III. Provider practice location address

8688 STATE ROUTE 93
JACKSON OH
45640
US

IV. Provider business mailing address

101 LAKEVIEW LN
IRONTON OH
45638-8097
US

V. Phone/Fax

Practice location:
  • Phone: 740-286-5026
  • Fax:
Mailing address:
  • Phone: 740-547-4287
  • Fax: 740-532-1715

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4036600
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0037761
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number114746
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: