Provider Demographics
NPI:1255085452
Name:PERRY, REGINA DOLORES (APRN)
Entity type:Individual
Prefix:
First Name:REGINA
Middle Name:DOLORES
Last Name:PERRY
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:REGINA
Other - Middle Name:DOLORES
Other - Last Name:CARRERAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2205 W LINCOLN AVE
Mailing Address - Street 2:
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98902-2437
Mailing Address - Country:US
Mailing Address - Phone:509-469-6305
Mailing Address - Fax:509-575-3398
Practice Address - Street 1:2205 W LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98902-2437
Practice Address - Country:US
Practice Address - Phone:509-469-6305
Practice Address - Fax:509-575-3398
Is Sole Proprietor?:No
Enumeration Date:2022-02-07
Last Update Date:2023-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN61452346363L00000X
FL11016556363LP0200X
WAAP61452375363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL113307200Medicaid