Provider Demographics
NPI:1386978153
Name:JUNKINS, JAMES P (PA-C)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:P
Last Name:JUNKINS
Suffix:
Gender:M
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 1:4500 13TH ST
Mailing Address - Street 2:
Mailing Address - City:GULFPORT
Mailing Address - State:MS
Mailing Address - Zip Code:39501-2515
Mailing Address - Country:US
Mailing Address - Phone:228-867-4856
Mailing Address - Fax:228-567-4857
Practice Address - Street 1:1340 BROAD AVE
Practice Address - Street 2:SUITE 440
Practice Address - City:GULFPORT
Practice Address - State:MS
Practice Address - Zip Code:39501-2404
Practice Address - Country:US
Practice Address - Phone:228-867-4856
Practice Address - Fax:228-867-4857
Is Sole Proprietor?:No
Enumeration Date:2009-09-28
Last Update Date:2016-12-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLPA 9105197363A00000X
MSPA00131363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant