Provider Demographics
NPI:1750152328
Name:PERRY, URSULA DAWN
Entity type:Individual
Prefix:
First Name:URSULA
Middle Name:DAWN
Last Name:PERRY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:URSULA
Other - Middle Name:DAWN
Other - Last Name:ANGEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6 MEADOW RD
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25314-2200
Mailing Address - Country:US
Mailing Address - Phone:304-206-8810
Mailing Address - Fax:
Practice Address - Street 1:401 6TH AVE
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:WV
Practice Address - Zip Code:25136-2199
Practice Address - Country:US
Practice Address - Phone:304-442-5151
Practice Address - Fax:304-442-7463
Is Sole Proprietor?:No
Enumeration Date:2024-01-12
Last Update Date:2024-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV88944163W00000X
WV118917363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse