Provider Demographics
NPI:1205222676
Name:PERRY, DIANE CATHERINE (MSN FNP-BC)
Entity Type:Individual
Prefix:MS
First Name:DIANE
Middle Name:CATHERINE
Last Name:PERRY
Suffix:
Gender:F
Credentials:MSN FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:106 WOODMERE DR
Mailing Address - Street 2:
Mailing Address - City:HOHENWALD
Mailing Address - State:TN
Mailing Address - Zip Code:38462-1224
Mailing Address - Country:US
Mailing Address - Phone:931-619-3250
Mailing Address - Fax:
Practice Address - Street 1:106 WOODMERE DR
Practice Address - Street 2:
Practice Address - City:HOHENWALD
Practice Address - State:TN
Practice Address - Zip Code:38462-1224
Practice Address - Country:US
Practice Address - Phone:931-619-3250
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-12
Last Update Date:2018-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS902876363L00000X
TN19835363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner