Provider Demographics
NPI:1740470368
Name:PERLEY, MARY JO (NP)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:JO
Last Name:PERLEY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
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Mailing Address - Street 1:PO BOX 87
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78291-0087
Mailing Address - Country:US
Mailing Address - Phone:210-358-9172
Mailing Address - Fax:210-358-9183
Practice Address - Street 1:4502 MEDICAL DR
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-4402
Practice Address - Country:US
Practice Address - Phone:210-358-0594
Practice Address - Fax:210-358-2135
Is Sole Proprietor?:No
Enumeration Date:2007-07-30
Last Update Date:2013-07-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TX565494363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8Y2633OtherBCBS
TXP00600828OtherRAILROAD MEDICARE
TX191830201Medicaid
TX191830201Medicaid