Provider Demographics
NPI:1114226289
Name:PERRINE, NYSSAH DAWN (RN, FPMHNP-BC)
Entity Type:Individual
Prefix:
First Name:NYSSAH
Middle Name:DAWN
Last Name:PERRINE
Suffix:
Gender:F
Credentials:RN, FPMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:424 S OAKES ST
Mailing Address - Street 2:
Mailing Address - City:SAN ANGELO
Mailing Address - State:TX
Mailing Address - Zip Code:76903-5944
Mailing Address - Country:US
Mailing Address - Phone:325-486-4500
Mailing Address - Fax:325-486-2968
Practice Address - Street 1:424 S OAKES ST
Practice Address - Street 2:
Practice Address - City:SAN ANGELO
Practice Address - State:TX
Practice Address - Zip Code:76903-5944
Practice Address - Country:US
Practice Address - Phone:325-486-4500
Practice Address - Fax:325-486-2968
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-15
Last Update Date:2011-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX729871363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health