Provider Demographics
NPI:1255428439
Name:PERRY, MICHAEL KENT (CRNA)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:KENT
Last Name:PERRY
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13811 CHARLES ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68154-3883
Mailing Address - Country:US
Mailing Address - Phone:402-492-8544
Mailing Address - Fax:402-391-8979
Practice Address - Street 1:8031 W CENTER RD
Practice Address - Street 2:SUITE 226
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68124-3134
Practice Address - Country:US
Practice Address - Phone:402-391-8978
Practice Address - Fax:402-391-8979
Is Sole Proprietor?:No
Enumeration Date:2006-10-06
Last Update Date:2012-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE100507367500000X
IAD-067145367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered