Individual
DERETSA PERRY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
310 N STATE OF FRANKLIN RD, SUITE 400, JOHNSON CITY, TN 37604-6008
(423) 979-6000
(423) 979-6011
Mailing address
310 N STATE OF FRANKLIN RD, SUITE 400, JOHNSON CITY, TN 37604-6008
(423) 979-6000
(423) 979-6011
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
21518
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1881147692
—
VA
05
—
Q024107
—
TN
Enumeration date
07/28/2016
Last updated
02/21/2017
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