Provider Demographics
NPI:1770916090
Name:PERRY, PASHALA (FNP-C)
Entity type:Individual
Prefix:MS
First Name:PASHALA
Middle Name:
Last Name:PERRY
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:951 GREENSIDE DR APT 8106
Mailing Address - Street 2:
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75080-1174
Mailing Address - Country:US
Mailing Address - Phone:214-329-6161
Mailing Address - Fax:
Practice Address - Street 1:3934 RICHMOND AVE
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71106-1030
Practice Address - Country:US
Practice Address - Phone:214-329-6161
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-11
Last Update Date:2021-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP124669363L00000X
LAAP07517363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner