Healthcare Provider Details

I. General information

NPI: 1659547354
Provider Name (Legal Business Name): KAREN L PERRY FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/02/2008
Last Update Date: 02/11/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12702 N IH 35
LIVE OAK TX
78233-2609
US

IV. Provider business mailing address

8109 FREDERICKSBURG RD PHYSICIAN PRACTICE SERVICES
SAN ANTONIO TX
78229-3311
US

V. Phone/Fax

Practice location:
  • Phone: 210-650-9669
  • Fax: 210-650-0750
Mailing address:
  • Phone: 210-560-9669
  • Fax: 210-650-0750

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number607778
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number607778
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: