Healthcare Provider Details

I. General information

NPI: 1750152328
Provider Name (Legal Business Name): URSULA DAWN PERRY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: URSULA DAWN ANGEL

II. Dates (important events)

Enumeration Date: 01/12/2024
Last Update Date: 03/13/2024
Certification Date: 03/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 6TH AVE
MONTGOMERY WV
25136-2199
US

IV. Provider business mailing address

6 MEADOW RD
CHARLESTON WV
25314-2200
US

V. Phone/Fax

Practice location:
  • Phone: 304-442-5151
  • Fax: 304-442-7463
Mailing address:
  • Phone: 304-206-8810
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number88944
License Number StateWV
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number118917
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: