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General NPI Number Information
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NPI Number | 1447628458
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Entity Type | Individual
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Provider Name | KEISHA PERRY PA
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Gender | Female
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Dates
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Enumeration Date | 09/08/2015
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Last Update Date | 10/07/2024
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Provider Practice Location Address
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Address Line | 14780 W MOUNTAIN VIEW BLVD STE 110
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City | SURPRISE
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State | AZ
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Zip | 85374-7280
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Country | US
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Telephone | 162-337-4777
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Fax |
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Provider Business Mailing Address
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Address Line | 14780 W MOUNTAIN VIEW BLVD STE 110
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City | SURPRISE
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State | AZ
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Zip | 85374-7280
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Country | US
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Telephone | 623-374-7774
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Fax | 855-420-6361
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 7125
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License Number State | AZ
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 2840
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License Number State | TN
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Taxonomy #3
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 0110006865
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License Number State | VA
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