1083238232 NPI number — MANDY LYNN PERRY MSN, RN, FNP-C

Table of content: MANDY LYNN PERRY MSN, RN, FNP-C (NPI 1083238232)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1083238232 NPI number — MANDY LYNN PERRY MSN, RN, FNP-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PERRY
Provider First Name:
MANDY
Provider Middle Name:
LYNN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MSN, RN, FNP-C
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1083238232
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
720 US HIGHWAY 259 N
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ORE CITY
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75683-5763
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
903-968-2847
Provider Business Mailing Address Fax Number:
903-968-8958

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
720 US HIGHWAY 259 N
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ORE CITY
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75683-5763
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
903-968-2847
Provider Business Practice Location Address Fax Number:
903-968-2216
Provider Enumeration Date:
06/03/2020

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LP2300X , with the licence number:  1003536 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LF0000X , with the licence number: 1003536 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 363LF0000X , with the licence number: 721246 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 163WI0500X , with the licence number: 1003536 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 9363417 . This is a "CIGNA" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 431976601 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: H000RJ8101 . This is a "BLUECROSS BLUESHEILD" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 1694561564 . This is a "AMERIGROUP" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 1083238232 . This is a "SUPERIOR HEALTH PLAN" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".