Healthcare Provider Details

I. General information

NPI: 1386073229
Provider Name (Legal Business Name): ANN PERRY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/01/2013
Last Update Date: 11/01/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 MED TECH PKWY STE 180
JOHNSON CITY TN
37604-2364
US

IV. Provider business mailing address

301 MED TECH PKWY STE 180
JOHNSON CITY TN
37604-2364
US

V. Phone/Fax

Practice location:
  • Phone: 423-794-5540
  • Fax: 423-926-3187
Mailing address:
  • Phone: 423-794-5540
  • Fax: 423-926-3187

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License Number81135
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: