Provider Demographics
NPI:1003046616
Name:PERRY, AMANDA LEIGH (DNP, FNP-C)
Entity Type:Individual
Prefix:DR
First Name:AMANDA
Middle Name:LEIGH
Last Name:PERRY
Suffix:
Gender:F
Credentials:DNP, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:665 112TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:COOPERSTOWN
Mailing Address - State:ND
Mailing Address - Zip Code:58425-9264
Mailing Address - Country:US
Mailing Address - Phone:601-870-0774
Mailing Address - Fax:701-797-3328
Practice Address - Street 1:665 112TH AVE NE
Practice Address - Street 2:
Practice Address - City:COOPERSTOWN
Practice Address - State:ND
Practice Address - Zip Code:58425-9264
Practice Address - Country:US
Practice Address - Phone:601-870-0774
Practice Address - Fax:701-797-3328
Is Sole Proprietor?:No
Enumeration Date:2009-07-16
Last Update Date:2016-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NDR41616363LF0000X
MSR863756363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS07736054Medicaid
MS302I509838Medicare PIN