Provider Demographics
NPI:1265116610
Name:PERRY, AMANDA LEIGH (AG-ACNP)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:LEIGH
Last Name:PERRY
Suffix:
Gender:F
Credentials:AG-ACNP
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:LEIGH
Other - Last Name:ENGLAND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1140 S KNOXVILLE AVE STE D
Mailing Address - Street 2:
Mailing Address - City:SAINT MARYS
Mailing Address - State:OH
Mailing Address - Zip Code:45885-2609
Mailing Address - Country:US
Mailing Address - Phone:419-300-1129
Mailing Address - Fax:
Practice Address - Street 1:200 SAINT CLAIR AVE STE 101
Practice Address - Street 2:
Practice Address - City:SAINT MARYS
Practice Address - State:OH
Practice Address - Zip Code:45885-2400
Practice Address - Country:US
Practice Address - Phone:419-394-9522
Practice Address - Fax:419-394-9523
Is Sole Proprietor?:No
Enumeration Date:2023-06-14
Last Update Date:2025-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.0034318363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner