Healthcare Provider Details

I. General information

NPI: 1104280676
Provider Name (Legal Business Name): MS. KIONNA PERRY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/11/2016
Last Update Date: 04/11/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3900 FORD RD 104E
PHILADELPHIA PA
19131-2039
US

IV. Provider business mailing address

3979 LANKENAU AVE APT 1
PHILADELPHIA PA
19131-2808
US

V. Phone/Fax

Practice location:
  • Phone: 215-921-6624
  • Fax: 215-921-6715
Mailing address:
  • Phone: 610-324-7807
  • Fax: 215-921-6715

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code372500000X
TaxonomyChore Provider
License Number28383601
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number28383601
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number28383601
License Number StatePA
# 4
Primary TaxonomyN
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number28383601
License Number StatePA
# 5
Primary TaxonomyY
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number28383601
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: