Provider Demographics
NPI:1659547354
Name:PERRY, KAREN L (FNP)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:L
Last Name:PERRY
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 1:8109 FREDERICKSBURG RD
Mailing Address - Street 2:PHYSICIAN PRACTICE SERVICES
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-3311
Mailing Address - Country:US
Mailing Address - Phone:210-560-9669
Mailing Address - Fax:210-650-0750
Practice Address - Street 1:12702 N IH 35
Practice Address - Street 2:
Practice Address - City:LIVE OAK
Practice Address - State:TX
Practice Address - Zip Code:78233-2609
Practice Address - Country:US
Practice Address - Phone:210-650-9669
Practice Address - Fax:210-650-0750
Is Sole Proprietor?:No
Enumeration Date:2008-05-02
Last Update Date:2022-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX607778363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX280802402Medicaid
TXP01136166OtherRR MCR
P01136166OtherRAILROAD MEDICARE
TX884N83OtherBCBSTX
TX884N83OtherBCBSTX
TX00Z236Medicare PIN