| Doctor Name: | RANDI L PERRY |
| NPI Number: | 1740622497 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | APN |
| License Number: | A003914 |
| Business Practice Address: | 3519 Highway 63 Black Rock, AR - 724159022 |
| Business Phone Number: | 8708784005 |
| Business Fax Number: | 8709947488 |
| Mailing Address: | 3519 Highway 63, BLACK ROCK |
| State: | AR |
| Postal Code: | 724159022 |
| Phone Number: | 8708783005 |
| Fax Number: | 8709947488 |
| NPI Enumeration Date: | 07/23/2013 |
| NPI Last Update Date: | 07/20/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | A003914 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | AR |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |