Provider Demographics
NPI:1750953964
Name:PERRY, ANGEL LYNN (PMHNP)
Entity type:Individual
Prefix:MRS
First Name:ANGEL
Middle Name:LYNN
Last Name:PERRY
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3503 KEPLINGER RD
Mailing Address - Street 2:
Mailing Address - City:MAYSVILLE
Mailing Address - State:WV
Mailing Address - Zip Code:26833-7735
Mailing Address - Country:US
Mailing Address - Phone:304-703-4187
Mailing Address - Fax:
Practice Address - Street 1:3194 CORE RD
Practice Address - Street 2:
Practice Address - City:PARKERSBURG
Practice Address - State:WV
Practice Address - Zip Code:26104-1556
Practice Address - Country:US
Practice Address - Phone:304-485-5185
Practice Address - Fax:304-485-0051
Is Sole Proprietor?:No
Enumeration Date:2021-07-15
Last Update Date:2023-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV83936163W00000X
WV107442363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse