Provider Demographics
NPI:1659087054
Name:PEREA, STORMIE SYNOAH
Entity type:Individual
Prefix:
First Name:STORMIE
Middle Name:SYNOAH
Last Name:PEREA
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 1:692 COUNTY ROAD 148
Mailing Address - Street 2:
Mailing Address - City:TOWN CREEK
Mailing Address - State:AL
Mailing Address - Zip Code:35672-5308
Mailing Address - Country:US
Mailing Address - Phone:256-309-8809
Mailing Address - Fax:
Practice Address - Street 1:2407 HELTON DR
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:AL
Practice Address - Zip Code:35630-1067
Practice Address - Country:US
Practice Address - Phone:256-718-5900
Practice Address - Fax:256-718-5918
Is Sole Proprietor?:No
Enumeration Date:2023-01-30
Last Update Date:2024-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL3-001636363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health