Provider Demographics
NPI:1154637932
Name:PERKINS, IAN (PA)
Entity Type:Individual
Prefix:
First Name:IAN
Middle Name:
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 1:1911 K M WICKER MEMORIAL DR
Mailing Address - Street 2:
Mailing Address - City:SANFORD
Mailing Address - State:NC
Mailing Address - Zip Code:27330-5070
Mailing Address - Country:US
Mailing Address - Phone:919-439-9251
Mailing Address - Fax:
Practice Address - Street 1:1911 K M WICKER MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:SANFORD
Practice Address - State:NC
Practice Address - Zip Code:27330-5070
Practice Address - Country:US
Practice Address - Phone:919-439-9251
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-31
Last Update Date:2023-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH0868363A00000X
NC0010-08049363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH3076809Medicaid
NHT400183879Medicare PIN
NHRAILROAD P00922200Medicare PIN
NH30339323Medicaid