Provider Demographics
NPI:1487368197
Name:PERRY, INDYA ELIZABETH (FNP-BC)
Entity type:Individual
Prefix:
First Name:INDYA
Middle Name:ELIZABETH
Last Name:PERRY
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22945 N BELLWOOD DR
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48034-6228
Mailing Address - Country:US
Mailing Address - Phone:248-506-0549
Mailing Address - Fax:
Practice Address - Street 1:22201 MOROSS RD
Practice Address - Street 2:ST JOHN PROF BLDG STE 170
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48236-2152
Practice Address - Country:US
Practice Address - Phone:313-886-8787
Practice Address - Fax:313-887-4103
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-09
Last Update Date:2025-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704317313363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty