Provider Demographics
NPI:1346596772
Name:PERRY, MONICA BEATRICE (CNA)
Entity Type:Individual
Prefix:MS
First Name:MONICA
Middle Name:BEATRICE
Last Name:PERRY
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14479 ROCKYPOINT DR
Mailing Address - Street 2:
Mailing Address - City:FLORISSANT
Mailing Address - State:MO
Mailing Address - Zip Code:63034-2647
Mailing Address - Country:US
Mailing Address - Phone:314-456-3620
Mailing Address - Fax:314-738-9909
Practice Address - Street 1:14479 ROCKYPOINT DR
Practice Address - Street 2:
Practice Address - City:FLORISSANT
Practice Address - State:MO
Practice Address - Zip Code:63034-2647
Practice Address - Country:US
Practice Address - Phone:314-456-3620
Practice Address - Fax:314-738-9909
Is Sole Proprietor?:No
Enumeration Date:2012-08-03
Last Update Date:2020-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO145100376K00000X
MOX012225603747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
No376K00000XNursing Service Related ProvidersNurse's Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO260027015Medicaid