Provider Demographics
NPI:1164433694
Name:PERRY, CELESTE DIANE (APRN, NNP-C)
Entity Type:Individual
Prefix:MISS
First Name:CELESTE
Middle Name:DIANE
Last Name:PERRY
Suffix:
Gender:F
Credentials:APRN, NNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10580 SPRINGGLEN CT
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70810-0746
Mailing Address - Country:US
Mailing Address - Phone:901-628-5752
Mailing Address - Fax:
Practice Address - Street 1:107 MONTROSE AVE.
Practice Address - Street 2:SUITE D
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70503
Practice Address - Country:US
Practice Address - Phone:337-981-9316
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP04947363LN0005X
TNAPN0000011811363LN0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LN0005XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal, Critical Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
LAAPO4947OtherLOUISIANA LICENSE
TNAPN0000011811OtherTENNESSEE LICENSE