Provider Demographics
NPI:1093606535
Name:PERKINS, MICAH
Entity type:Individual
Prefix:
First Name:MICAH
Middle Name:
Last Name:PERKINS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:455 E PEBBLE RD # 232236
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89123-3084
Mailing Address - Country:US
Mailing Address - Phone:407-580-9607
Mailing Address - Fax:
Practice Address - Street 1:400 S 4TH ST # 232236
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89101-6201
Practice Address - Country:US
Practice Address - Phone:407-580-9607
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-12
Last Update Date:2025-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
No171W00000XOther Service ProvidersContractor