Provider Demographics
NPI:1790160117
Name:PERRY, ELDRA (RN)
Entity Type:Individual
Prefix:MRS
First Name:ELDRA
Middle Name:
Last Name:PERRY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:571 BYRON DR
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38109-5553
Mailing Address - Country:US
Mailing Address - Phone:901-276-2357
Mailing Address - Fax:901-398-4768
Practice Address - Street 1:1750 MADISON AVE STE 401
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38104-6428
Practice Address - Country:US
Practice Address - Phone:901-276-2357
Practice Address - Fax:901-276-2357
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-27
Last Update Date:2015-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN035097261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care