Provider Demographics
NPI:1164008793
Name:PERKINS, CONNIE
Entity Type:Individual
Prefix:
First Name:CONNIE
Middle Name:
Last Name:PERKINS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3027 CABWAY LINGO PARK ROAD
Mailing Address - Street 2:
Mailing Address - City:DUNLOW
Mailing Address - State:WV
Mailing Address - Zip Code:25511
Mailing Address - Country:US
Mailing Address - Phone:304-690-6764
Mailing Address - Fax:
Practice Address - Street 1:3027 CABWAY LINGO PARK ROAD
Practice Address - Street 2:
Practice Address - City:DUNLOW
Practice Address - State:WV
Practice Address - Zip Code:25511
Practice Address - Country:US
Practice Address - Phone:304-690-6764
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-23
Last Update Date:2021-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker