MEDICARE: KRISTI RUNION PERRY RN, IBCLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163WM0102X	Maternal Newborn Registered Nurse	TN100653	TN

General Provider Information

NPI Number	:	1134965437
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTI RUNION PERRY RN, IBCLC

Provider Business Mailing Address
First Line	:	875 SAMPLES CHAPEL RD SE
Second Line	:
City	:	CLEVELAND
State	:	TN
Zip	:	37323-8905
Country	:	US
Telephone Number	:	423-241-0524
Fax Number	:

Provider Business Practice Location Address
First Line	:	875 SAMPLES CHAPEL RD SE
Second Line	:
City	:	CLEVELAND
State	:	TN
Zip	:	37323-8905
Country	:	US
Telephone Number	:	423-241-0524
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/05/2024
Last Update Date	:	05/04/2026

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