Provider Demographics
NPI:1851684674
Name:PERRY, JENNINGS MICHAEL (RN)
Entity Type:Individual
Prefix:
First Name:JENNINGS
Middle Name:MICHAEL
Last Name:PERRY
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6991 PEARCE LN
Mailing Address - Street 2:
Mailing Address - City:CANAL WINCHESTER
Mailing Address - State:OH
Mailing Address - Zip Code:43110-8619
Mailing Address - Country:US
Mailing Address - Phone:614-203-3515
Mailing Address - Fax:
Practice Address - Street 1:8359 DOVE PKWY
Practice Address - Street 2:
Practice Address - City:CANAL WINCHESTER
Practice Address - State:OH
Practice Address - Zip Code:43110-7762
Practice Address - Country:US
Practice Address - Phone:614-203-3515
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-26
Last Update Date:2015-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH353367163W00000X
OH17756363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse