Healthcare Provider Details

I. General information

NPI: 1659036879
Provider Name (Legal Business Name): CELENA TERRI PERRY FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CELENA TERRI DAVIS

II. Dates (important events)

Enumeration Date: 11/02/2021
Last Update Date: 01/26/2022
Certification Date: 01/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

176 W UNIVERSITY PKWY STE C
JACKSON TN
38305-1618
US

IV. Provider business mailing address

1185 BROADWAY RD S
LEXINGTON TN
38351-6269
US

V. Phone/Fax

Practice location:
  • Phone: 731-660-6916
  • Fax: 731-668-4557
Mailing address:
  • Phone: 731-418-0612
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number30624
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: