Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208D00000X | General Practice Physician | N7848 | AR |
NPI | 1033198056 |
---|---|
Provider Name | Dr. Karen Ann Perry |
First Address | Mena, AR 71953-5515 |
Second Address | Mena, AR 71953-7715 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/01/2006 |
Last Update Date | 13/01/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
117826001 | (05) | AR |
E67067 | (02) | AR |