Provider Demographics
NPI:1033198056
Name:PERRY, KAREN ANN
Entity Type:Individual
Prefix:DR
First Name:KAREN
Middle Name:ANN
Last Name:PERRY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 CRESTWOOD CIR
Mailing Address - Street 2:
Mailing Address - City:MENA
Mailing Address - State:AR
Mailing Address - Zip Code:71953-5515
Mailing Address - Country:US
Mailing Address - Phone:479-394-1600
Mailing Address - Fax:479-394-1606
Practice Address - Street 1:1690 POLK 67
Practice Address - Street 2:
Practice Address - City:MENA
Practice Address - State:AR
Practice Address - Zip Code:71953-7715
Practice Address - Country:US
Practice Address - Phone:479-394-1600
Practice Address - Fax:479-394-1606
Is Sole Proprietor?:No
Enumeration Date:2006-01-10
Last Update Date:2009-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARN7848208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR117826001Medicaid
AR53989Medicare ID - Type Unspecified
ARE67067Medicare UPIN