Provider Demographics
NPI:1205859741
Name:PERRY, JUDITH W (FNP)
Entity Type:Individual
Prefix:MRS
First Name:JUDITH
Middle Name:W
Last Name:PERRY
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 669
Mailing Address - Street 2:118 HERTFORD COUNTY HIGH SCHOOL
Mailing Address - City:AHOSKIE
Mailing Address - State:NC
Mailing Address - Zip Code:27910-0669
Mailing Address - Country:US
Mailing Address - Phone:252-209-0237
Mailing Address - Fax:252-209-0197
Practice Address - Street 1:305 BEECHWOOD BLVD
Practice Address - Street 2:
Practice Address - City:MURFREESBORO
Practice Address - State:NC
Practice Address - Zip Code:27855-1134
Practice Address - Country:US
Practice Address - Phone:252-398-3323
Practice Address - Fax:252-398-4799
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2011-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200629363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2596505AMedicare ID - Type Unspecified
NCS46197Medicare UPIN