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NPI Code Detail

MEDICARE: KEONNA PERRY

MEDICARE: KEONNA PERRY
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
1106S00000XBehavior TechnicianW976934FL

General Provider Information

NPI Number : 1184575789
Entity Type Code : Individual
Provider Name (Legal Business Name) : KEONNA PERRY
Provider Business Mailing Address
First Line : 8745 PALM BREEZE RD APT 1516
Second Line :
City : JACKSONVILLE
State : FL
Zip : 32256-3765
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 12735 GRAN BAY PKWY W STE 204
Second Line :
City : JACKSONVILLE
State : FL
Zip : 32258-4499
Country : US
Telephone Number : 888-754-0398
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/09/2026
Last Update Date : 02/09/2026

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Directions to “ KEONNA PERRY ” Practice Location

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