Provider Demographics
NPI:1093857187
Name:PERKINS, DEANDREA RICO (MD)
Entity Type:Individual
Prefix:
First Name:DEANDREA
Middle Name:RICO
Last Name:PERKINS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:815 E PARRISH AVE
Mailing Address - Street 2:SUITE 460
Mailing Address - City:OWENSBORO
Mailing Address - State:KY
Mailing Address - Zip Code:42303-3222
Mailing Address - Country:US
Mailing Address - Phone:270-684-5005
Mailing Address - Fax:270-926-4432
Practice Address - Street 1:815 E PARRISH AVE
Practice Address - Street 2:SUITE 460
Practice Address - City:OWENSBORO
Practice Address - State:KY
Practice Address - Zip Code:42303-3222
Practice Address - Country:US
Practice Address - Phone:270-684-5005
Practice Address - Fax:270-926-4432
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-13
Last Update Date:2010-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYTP258207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology