Provider Demographics
NPI:1366162505
Name:PERDUE, KRISTA JEAN (PSYD)
Entity type:Individual
Prefix:DR
First Name:KRISTA
Middle Name:JEAN
Last Name:PERDUE
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29439 N 122ND DR
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85383-2416
Mailing Address - Country:US
Mailing Address - Phone:314-330-3292
Mailing Address - Fax:
Practice Address - Street 1:4425 W OLIVE AVE STE 151
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85302-3855
Practice Address - Country:US
Practice Address - Phone:408-972-3095
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-29
Last Update Date:2023-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensic