Healthcare Provider Details

I. General information

NPI: 1063374817
Provider Name (Legal Business Name): RYLEA JENSEN PERKINS PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: RYLEA JENSEN WISCHMEIER PA

II. Dates (important events)

Enumeration Date: 12/01/2025
Last Update Date: 12/01/2025
Certification Date: 12/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2108 PLEASANT VIEW DR APT 204
JOHNSON CITY TN
37604
US

IV. Provider business mailing address

2108 PLEASANT VIEW DR APT 204
JOHNSON CITY TN
37604
US

V. Phone/Fax

Practice location:
  • Phone: 615-891-9794
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number6831
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: