Provider Demographics
NPI:1942790035
Name:MAYES, PERI ANNE (PMHNP-BC)
Entity Type:Individual
Prefix:MS
First Name:PERI
Middle Name:ANNE
Last Name:MAYES
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4360 HOLLY HILLS BLVD
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63116-2253
Mailing Address - Country:US
Mailing Address - Phone:314-481-3660
Mailing Address - Fax:
Practice Address - Street 1:535 NE 6TH AVE
Practice Address - Street 2:
Practice Address - City:ESTACADA
Practice Address - State:OR
Practice Address - Zip Code:97023-9312
Practice Address - Country:US
Practice Address - Phone:503-630-8550
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-14
Last Update Date:2023-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO133957363LP0808X
OR202005499363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500780769Medicaid
MO133957OtherMISSOURI STATE BOARD OF NURSING--REGISTERED NURSE #
2018001235OtherAMERICAN NURSES CREDENTIALING CENTER--PMHNP CERTIFICATION