MEDICARE: KRISTIN 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
1	2082S0099X	Plastic Surgery Within the Head and Neck (Plastic Surgery) Physician	0110007981	VA

General Provider Information

NPI Number	:	1639849508
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTIN PERRY

Provider Business Mailing Address
First Line	:	3030 JEHOSSEE ST APT 104
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27616-5936
Country	:	US
Telephone Number	:	615-557-2509
Fax Number	:

Provider Business Practice Location Address
First Line	:	5250 CHEROKEE AVE STE 301
Second Line	:
City	:	ALEXANDRIA
State	:	VA
Zip	:	22312-2052
Country	:	US
Telephone Number	:	703-647-2762
Fax Number	:

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

Provider Enumeration Date	:	09/14/2021
Last Update Date	:	09/14/2021

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Directions to “ KRISTIN PERRY ” Practice Location

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