=====================================================
General NPI Number Information
=====================================================
NPI Number | 1124627690
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ALISON DENISE PERRYMAN MSN, RN, PMHNP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/25/2020
-----------------------------------------------------
Last Update Date | 06/21/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 220 OAK TREE DR
-----------------------------------------------------
City | HERNANDO
-----------------------------------------------------
State | MS
-----------------------------------------------------
Zip | 38632-1196
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 662-510-8606
-----------------------------------------------------
Fax | 844-397-3305
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 770
-----------------------------------------------------
City | HERNANDO
-----------------------------------------------------
State | MS
-----------------------------------------------------
Zip | 38632-0770
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 662-510-8606
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LP0808X
-----------------------------------------------------
Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
-----------------------------------------------------
License Number | 905858
-----------------------------------------------------
License Number State | MS
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 163W00000X
-----------------------------------------------------
Taxonomy Name | Registered Nurse
-----------------------------------------------------
License Number | 870446
-----------------------------------------------------
License Number State | MS
-----------------------------------------------------