DERETSA PERRY NP NPI 1881147692

NPI Information

  • NPI: 1881147692
  • Provider Name: DERETSA PERRY, NP
  • Classification: Nurse Practitioner - 363LF0000X
  • Specialization: Family
  • Entity Type: Individual
  • PECOS Registration: Yes
  • Address: 310 N STATE OF FRANKLIN RD
    SUITE 400
    JOHNSON CITY, TN
    ZIP 37604
  • Phone: (423) 979-6000

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NPI Details

Deretsa Perry, NP is a family nurse practitioner in Johnson City, TN. Deretsa Perry, NP NPI is 1881147692. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a female.

The provider's business location address is:

310 N STATE OF FRANKLIN RD
SUITE 400
JOHNSON CITY, TN
ZIP 37604-008
Phone: (423) 979-6000
Fax: (423) 979-6011

The NPI 1881147692 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Power Mobility Devices.

The enumeration date for this NPI number is 7/28/2016 and was last updated on 2/21/2017.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1363LF0000XNurse PractitionerFamily21518TENNESSEEYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
1Q024107MEDICAIDTENNESSEE
21881147692MEDICAIDVIRGINIA
310350I4942MEDICARE PINTENNESSEE

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

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