Provider Demographics
NPI:1740821024
Name:PERRY, JAIMIE (NP-C)
Entity type:Individual
Prefix:MRS
First Name:JAIMIE
Middle Name:
Last Name:PERRY
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8500 N 103RD ST W
Mailing Address - Street 2:
Mailing Address - City:VALLEY CENTER
Mailing Address - State:KS
Mailing Address - Zip Code:67147-8125
Mailing Address - Country:US
Mailing Address - Phone:316-807-1578
Mailing Address - Fax:
Practice Address - Street 1:3801 S OLIVER ST
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67210-2112
Practice Address - Country:US
Practice Address - Phone:316-526-3511
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-08
Last Update Date:2019-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS53-78865-082363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner