Provider Demographics
NPI:1518959584
Name:PERRIGO, FELESHA DALE (FNP)
Entity Type:Individual
Prefix:MRS
First Name:FELESHA
Middle Name:DALE
Last Name:PERRIGO
Suffix:
Gender:F
Credentials:FNP
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 60
Mailing Address - Street 2:
Mailing Address - City:BOONEVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:38829-0060
Mailing Address - Country:US
Mailing Address - Phone:662-720-4919
Mailing Address - Fax:662-720-4980
Practice Address - Street 1:101 MIMOSA ST
Practice Address - Street 2:
Practice Address - City:BOONEVILLE
Practice Address - State:MS
Practice Address - Zip Code:38829-2911
Practice Address - Country:US
Practice Address - Phone:662-720-4919
Practice Address - Fax:662-720-4980
Is Sole Proprietor?:No
Enumeration Date:2005-08-16
Last Update Date:2007-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR763457363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00125681Medicaid
MS00125681Medicaid