Provider Demographics
NPI:1174592430
Name:PERRY, KERRI LYNN (MD)
Entity type:Individual
Prefix:DR
First Name:KERRI
Middle Name:LYNN
Last Name:PERRY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 911230
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75391-1230
Mailing Address - Country:US
Mailing Address - Phone:940-382-1022
Mailing Address - Fax:940-323-1190
Practice Address - Street 1:2600 SCRIPTURE ST
Practice Address - Street 2:
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76201-4315
Practice Address - Country:US
Practice Address - Phone:940-243-9759
Practice Address - Fax:940-483-9550
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-17
Last Update Date:2021-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ0192208600000X, 2086X0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086X0206XAllopathic & Osteopathic PhysiciansSurgerySurgical Oncology
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0045HAOtherBLUE CROSS BLUE SHIELD
TX2606443OtherAETNA
TX1245557-05Medicaid
TX124555706Medicaid