Provider Demographics
NPI:1689920134
Name:PERRY, MICHELLE LYNN (ACNP)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:LYNN
Last Name:PERRY
Suffix:
Gender:F
Credentials:ACNP
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:LYNN
Other - Last Name:PARENT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ACNP, PMHNP-BC
Mailing Address - Street 1:185 GEORGETOWN ROAD
Mailing Address - Street 2:C/O MICHELLE PERRY
Mailing Address - City:BOXFORD
Mailing Address - State:MA
Mailing Address - Zip Code:01921
Mailing Address - Country:US
Mailing Address - Phone:860-671-0380
Mailing Address - Fax:
Practice Address - Street 1:10 BRICKETTS MILL RD STE D1
Practice Address - Street 2:
Practice Address - City:HAMPSTEAD
Practice Address - State:NH
Practice Address - Zip Code:03841-2396
Practice Address - Country:US
Practice Address - Phone:860-671-0380
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-01
Last Update Date:2024-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH084712-23363LP0808X
MARN2265952363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health