Individual
MARY JO PERLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
4502 MEDICAL DR, SAN ANTONIO, TX 78229-4402
(210) 358-0594
(210) 358-2135
Mailing address
PO BOX 87, SAN ANTONIO, TX 78291-0087
(210) 358-9172
(210) 358-9183
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
565494
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
191830201
—
TX
01
—
8Y2633
BCBS
TX
01
—
P00600828
RAILROAD MEDICARE
TX
Enumeration date
07/30/2007
Last updated
07/22/2013
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