Basic Information
| Provider Information | |||||||||
| NPI: | 1003190075 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PERRY | ||||||||
| FirstName: | DEETT | ||||||||
| MiddleName: | P. | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | LPN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 406 N SPRING ST | ||||||||
| Address2: | |||||||||
| City: | MCMINNVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 371102134 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9315071212 | ||||||||
| FaxNumber: | 9315071217 | ||||||||
| Practice Location | |||||||||
| Address1: | 920 UNIVERSITY ST | ||||||||
| Address2: | |||||||||
| City: | MARTIN | ||||||||
| State: | TN | ||||||||
| PostalCode: | 382371605 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7315878808 | ||||||||
| FaxNumber: | 7315878810 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/07/2011 | ||||||||
| LastUpdateDate: | 10/07/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 164W00000X | LPN0000072190 | TN | Y | Nursing Service Providers | Licensed Practical Nurse |
ID Information
| ID | Type | State | Issuer | Description | LPN0000072190 | 01 | TN | LICENSE | OTHER |