Provider Demographics
NPI:1437291796
Name:PERUCHI, KIM (MHPP)
Entity Type:Individual
Prefix:MRS
First Name:KIM
Middle Name:
Last Name:PERUCHI
Suffix:
Gender:F
Credentials:MHPP
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 2578
Mailing Address - Street 2:
Mailing Address - City:BATESVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72503-2578
Mailing Address - Country:US
Mailing Address - Phone:870-793-8900
Mailing Address - Fax:870-793-4258
Practice Address - Street 1:319 HWY 14 SOUTH #1
Practice Address - Street 2:
Practice Address - City:YELLVILLE
Practice Address - State:AR
Practice Address - Zip Code:72687
Practice Address - Country:US
Practice Address - Phone:870-449-5177
Practice Address - Fax:870-449-5178
Is Sole Proprietor?:No
Enumeration Date:2007-02-13
Last Update Date:2009-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator