Provider Demographics
NPI:1366797128
Name:PERRY, MARY KATHLEEN BOONE (FNP)
Entity type:Individual
Prefix:MRS
First Name:MARY
Middle Name:KATHLEEN BOONE
Last Name:PERRY
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 ACADEMY ST S
Mailing Address - Street 2:
Mailing Address - City:AHOSKIE
Mailing Address - State:NC
Mailing Address - Zip Code:27910-3264
Mailing Address - Country:US
Mailing Address - Phone:252-209-3000
Mailing Address - Fax:
Practice Address - Street 1:700 ACADEMY ST S
Practice Address - Street 2:
Practice Address - City:AHOSKIE
Practice Address - State:NC
Practice Address - Zip Code:27910-3264
Practice Address - Country:US
Practice Address - Phone:252-209-3867
Practice Address - Fax:252-209-3490
Is Sole Proprietor?:No
Enumeration Date:2012-07-18
Last Update Date:2025-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC225340363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7006246Medicaid
NC8872480OtherCIGNA
NCNC8942AMedicare UPIN