Basic Information
| Provider Information | |||||||||
| NPI: | 1255845392 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PERRY | ||||||||
| FirstName: | THERESA | ||||||||
| MiddleName: | KATHERINE | ||||||||
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| Credential: | APRN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 890 S PALAFOX ST UNIT 300 | ||||||||
| Address2: | |||||||||
| City: | PENSACOLA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 325025905 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8504331656 | ||||||||
| FaxNumber: | 8504331996 | ||||||||
| Practice Location | |||||||||
| Address1: | 890 S PALAFOX ST UNIT 300 | ||||||||
| Address2: | |||||||||
| City: | PENSACOLA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 325025905 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8504331656 | ||||||||
| FaxNumber: | 8504331996 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/28/2017 | ||||||||
| LastUpdateDate: | 06/28/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/28/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LP0808X | 23492 | TN | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psych/Mental Health |
No ID Information.