Deretsa Perry, NP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

21518 Issued in TN

Practice address

310 N State of Franklin Rd
Suite 400
Johnson City, TN 37604-6008

Phone

(423) 979-6000

Fax

(423) 979-6011

NPI assigned

Jul 28, 2016

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1469664000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1487635200000",
    "number": "1881147692",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "310 N STATE OF FRANKLIN RD",
            "address_2": "SUITE 400",
            "city": "JOHNSON CITY",
            "state": "TN",
            "postal_code": "376046008",
            "telephone_number": "423-979-6000",
            "fax_number": "423-979-6011"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "310 N STATE OF FRANKLIN RD",
            "address_2": "SUITE 400",
            "city": "JOHNSON CITY",
            "state": "TN",
            "postal_code": "376046008",
            "telephone_number": "423-979-6000",
            "fax_number": "423-979-6011"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PERRY",
        "first_name": "DERETSA",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-07-28",
        "last_updated": "2017-02-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "TN",
            "license": "21518",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1881147692",
            "state": "VA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "Q024107",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Katarina Perri, DPM
• Ann Perry
• Caroline Rhea Perry, NP
• Christopher Alan Perry, DC
• David Kendall Perry, DC
• Gabriel Thomas Perry
• Lewis James Perry, LPC
• Melodie Sue Perry, MS, OTR/L
• Robert Calvin Perry Jr.
• Robin Colleen Perry, OTR/L

• Family Nurse Practitioner in Johnson City, TN
• Providers in Johnson City, TN by specialty
• Family Nurse Practitioner in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 21, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.