Provider Demographics
NPI:1225150667
Name:PERRY, MECHELLE T (CFNP)
Entity Type:Individual
Prefix:
First Name:MECHELLE
Middle Name:T
Last Name:PERRY
Suffix:
Gender:F
Credentials:CFNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 100
Mailing Address - Street 2:
Mailing Address - City:MEDINA
Mailing Address - State:TN
Mailing Address - Zip Code:38355-0100
Mailing Address - Country:US
Mailing Address - Phone:731-783-0400
Mailing Address - Fax:731-783-0402
Practice Address - Street 1:209 GRACE CV
Practice Address - Street 2:
Practice Address - City:MEDINA
Practice Address - State:TN
Practice Address - Zip Code:38355-8785
Practice Address - Country:US
Practice Address - Phone:731-783-0400
Practice Address - Fax:731-783-0402
Is Sole Proprietor?:No
Enumeration Date:2007-04-05
Last Update Date:2015-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN105786363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3902551Medicaid
4088128OtherBLUE CROSS BLUE SHIELD OF TN PIN
TNP24730Medicare UPIN
TN3902551Medicare PIN