Provider Demographics
NPI:1578214706
Name:PERRY, BRIANNA (PA-C)
Entity type:Individual
Prefix:MS
First Name:BRIANNA
Middle Name:
Last Name:PERRY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28A TUPELO DR
Mailing Address - Street 2:
Mailing Address - City:WEST KINGSTON
Mailing Address - State:RI
Mailing Address - Zip Code:02892
Mailing Address - Country:US
Mailing Address - Phone:603-557-1586
Mailing Address - Fax:
Practice Address - Street 1:53 GRANITE STREET
Practice Address - Street 2:SUITE D
Practice Address - City:NEW LONDON
Practice Address - State:CT
Practice Address - Zip Code:06320
Practice Address - Country:US
Practice Address - Phone:860-447-1419
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-10
Last Update Date:2024-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT6398207N00000X
RIPA01558363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty