Healthcare Provider Details

I. General information

NPI: 1750535860
Provider Name (Legal Business Name): MICHELLE BARBOUR PERRY NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MICHELLE E BARBOUR NP

II. Dates (important events)

Enumeration Date: 11/17/2008
Last Update Date: 02/28/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11803 JEFFERSON AVE STE 110
NEWPORT NEWS VA
23606-4390
US

IV. Provider business mailing address

856 J CLYDE MORRIS BLVD STE A
NEWPORT NEWS VA
23601-1318
US

V. Phone/Fax

Practice location:
  • Phone: 757-873-0360
  • Fax: 757-873-0847
Mailing address:
  • Phone: 757-594-4006
  • Fax: 757-534-5190

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number0024166299
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number0001165137
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: