MEDICARE: AMBER PERRY RN

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	163W00000X	Registered Nurse	RN138243	LA
2	363LP2300X	Primary Care Nurse Practitioner	227429	LA

General Provider Information

NPI Number	:	1982166294
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMBER PERRY RN

Provider Business Mailing Address
First Line	:	4008 S BAMBOO DR
Second Line	:
City	:	HARVEY
State	:	LA
Zip	:	70058-5823
Country	:	US
Telephone Number	:	504-269-7550
Fax Number	:

Provider Business Practice Location Address
First Line	:	3218 SAINT CLAUDE AVE
Second Line	:
City	:	NEW ORLEANS
State	:	LA
Zip	:	70117-6659
Country	:	US
Telephone Number	:	504-324-7790
Fax Number	:

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

Provider Enumeration Date	:	04/04/2019
Last Update Date	:	09/29/2022

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