Provider Demographics
NPI:1710644810
Name:PERCH, GWENDOLYN DAWN (APRN)
Entity Type:Individual
Prefix:
First Name:GWENDOLYN
Middle Name:DAWN
Last Name:PERCH
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:234 BRENWOOD ST
Mailing Address - Street 2:
Mailing Address - City:BEREA
Mailing Address - State:KY
Mailing Address - Zip Code:40403-1637
Mailing Address - Country:US
Mailing Address - Phone:859-200-5940
Mailing Address - Fax:
Practice Address - Street 1:234 BRENWOOD ST
Practice Address - Street 2:
Practice Address - City:BEREA
Practice Address - State:KY
Practice Address - Zip Code:40403-1637
Practice Address - Country:US
Practice Address - Phone:859-985-0302
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-23
Last Update Date:2021-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3017059363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily