Healthcare Provider Details

I. General information

NPI: 1881317436
Provider Name (Legal Business Name): ANGELA ALIXANDREA PERRY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2022
Last Update Date: 09/20/2022
Certification Date: 09/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5187 US ROUTE 60 STE 13
HUNTINGTON WV
25705-2076
US

IV. Provider business mailing address

1505 E MUD RIVER RD
MILTON WV
25541-2104
US

V. Phone/Fax

Practice location:
  • Phone: 304-733-5010
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number82897
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: