Provider Demographics
NPI:1841699758
Name:PERRYMAN, CINDA (FNP)
Entity type:Individual
Prefix:
First Name:CINDA
Middle Name:
Last Name:PERRYMAN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 36
Mailing Address - Street 2:
Mailing Address - City:FAYETTE
Mailing Address - State:MS
Mailing Address - Zip Code:39069-0036
Mailing Address - Country:US
Mailing Address - Phone:601-786-8655
Mailing Address - Fax:601-786-8656
Practice Address - Street 1:225 COMMUNITY DR
Practice Address - Street 2:
Practice Address - City:FAYETTE
Practice Address - State:MS
Practice Address - Zip Code:39069-7701
Practice Address - Country:US
Practice Address - Phone:601-786-8655
Practice Address - Fax:601-786-8656
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-15
Last Update Date:2020-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR870575363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS01573825Medicaid