Healthcare Provider Details

I. General information

NPI: 1003634361
Provider Name (Legal Business Name): ANNA R PERRONE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/26/2024
Last Update Date: 07/02/2026
Certification Date: 07/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1510 CHURCHILL WAY
ROWLETT TX
75088-6035
US

IV. Provider business mailing address

1510 CHURCHILL WAY
ROWLETT TX
75088-6035
US

V. Phone/Fax

Practice location:
  • Phone: 817-565-3937
  • Fax:
Mailing address:
  • Phone: 817-565-3937
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA20550
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: