Provider Demographics
NPI:1124035928
Name:PERKINS, BRENT L (PA)
Entity type:Individual
Prefix:
First Name:BRENT
Middle Name:L
Last Name:PERKINS
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 4238
Mailing Address - Street 2:
Mailing Address - City:CALABASH
Mailing Address - State:NC
Mailing Address - Zip Code:28467-9820
Mailing Address - Country:US
Mailing Address - Phone:910-575-6538
Mailing Address - Fax:910-575-6541
Practice Address - Street 1:10195 BEACH DR SW # 5
Practice Address - Street 2:
Practice Address - City:CALABASH
Practice Address - State:NC
Practice Address - Zip Code:28467-2701
Practice Address - Country:US
Practice Address - Phone:910-575-6538
Practice Address - Fax:910-575-6541
Is Sole Proprietor?:No
Enumeration Date:2006-08-02
Last Update Date:2008-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC100328363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCP00395334OtherRAILROAD MEDICARE
NCP69056Medicare UPIN