Individual
JESSICA RAQUEL PEREZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MSN, APRN, FNP-BC
Contact information
Practice address
7926 PRESTON HWY STE 103, LOUISVILLE, KY 40219-3848
(502) 861-4652
(502) 861-4654
Mailing address
PO BOX 776351, CHICAGO, IL 60677-6351
(502) 588-9490
(502) 272-5116
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
3016635
KY
363LP0200X
Pediatric Nurse Practitioner
2021103660
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7100772410
—
KY
Enumeration date
09/07/2021
Last updated
10/25/2024
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