Provider Demographics
NPI:1548874332
Name:PERY, ALICIA
Entity type:Individual
Prefix:
First Name:ALICIA
Middle Name:
Last Name:PERY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5997 SHADY OAKS DR
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75034-7228
Mailing Address - Country:US
Mailing Address - Phone:469-438-8437
Mailing Address - Fax:
Practice Address - Street 1:5997 SHADY OAKS DR
Practice Address - Street 2:
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75034-7228
Practice Address - Country:US
Practice Address - Phone:469-438-8437
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-31
Last Update Date:2020-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXA9282OtherHCPCS
TXG0406OtherHCPCS
TXA9281OtherHCPCS
TXG0407OtherHCPCS
TXG0408OtherHCPCS
TXG0427OtherHCPCS
TXG0426OtherHCPCS
TXG0425OtherHCPCS