MEDICARE: MS. HOLLI O PERRY APN

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	363LF0000X	Family Nurse Practitioner	AP136330	TX

General Provider Information

NPI Number	:	1689172132
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. HOLLI O PERRY APN

Provider Business Mailing Address
First Line	:	711 E LAMAR BLVD
Second Line	:	STE 200
City	:	ARLINGTON
State	:	TX
Zip	:	76011-3800
Country	:	US
Telephone Number	:	817-795-7546
Fax Number	:	817-385-7568

Provider Business Practice Location Address
First Line	:	711 E LAMAR BLVD STE 200
Second Line	:
City	:	ARLINGTON
State	:	TX
Zip	:	76011-3800
Country	:	US
Telephone Number	:	817-795-7546
Fax Number	:

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

Provider Enumeration Date	:	01/30/2018
Last Update Date	:	02/12/2018

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