Provider Demographics
NPI:1659036879
Name:PERRY, CELENA TERRI (FNP)
Entity Type:Individual
Prefix:
First Name:CELENA
Middle Name:TERRI
Last Name:PERRY
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:CELENA
Other - Middle Name:TERRI
Other - Last Name:DAVIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1185 BROADWAY RD S
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:TN
Mailing Address - Zip Code:38351-6269
Mailing Address - Country:US
Mailing Address - Phone:731-418-0612
Mailing Address - Fax:
Practice Address - Street 1:176 W UNIVERSITY PKWY STE C
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:TN
Practice Address - Zip Code:38305-1618
Practice Address - Country:US
Practice Address - Phone:731-660-6916
Practice Address - Fax:731-668-4557
Is Sole Proprietor?:No
Enumeration Date:2021-11-02
Last Update Date:2022-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN30624363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily