Provider Demographics
NPI:1083238232
Name:PERRY, MANDY LYNN (MSN, RN, FNP-C)
Entity Type:Individual
Prefix:
First Name:MANDY
Middle Name:LYNN
Last Name:PERRY
Suffix:
Gender:F
Credentials:MSN, RN, FNP-C
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Mailing Address - Street 1:720 US HIGHWAY 259 N
Mailing Address - Street 2:
Mailing Address - City:ORE CITY
Mailing Address - State:TX
Mailing Address - Zip Code:75683-5763
Mailing Address - Country:US
Mailing Address - Phone:903-968-2847
Mailing Address - Fax:903-968-8958
Practice Address - Street 1:720 US HIGHWAY 259 N
Practice Address - Street 2:
Practice Address - City:ORE CITY
Practice Address - State:TX
Practice Address - Zip Code:75683-5763
Practice Address - Country:US
Practice Address - Phone:903-968-2847
Practice Address - Fax:903-968-2216
Is Sole Proprietor?:No
Enumeration Date:2020-06-03
Last Update Date:2022-11-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TX1003536363LP2300X, 363LF0000X, 163WI0500X
TX721246363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No163WI0500XNursing Service ProvidersRegistered NurseInfusion Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX9363417OtherCIGNA
TX431976601Medicaid
TXH000RJ8101OtherBLUECROSS BLUESHEILD
TX1694561564OtherAMERIGROUP
TX1083238232OtherSUPERIOR HEALTH PLAN