Provider Demographics
NPI:1184642316
Name:PERKINS, NANCY JO (CNM)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:JO
Last Name:PERKINS
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 16370
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43216-6370
Mailing Address - Country:US
Mailing Address - Phone:614-645-5500
Mailing Address - Fax:614-458-1849
Practice Address - Street 1:1180 E MAIN ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43205-1902
Practice Address - Country:US
Practice Address - Phone:614-645-5535
Practice Address - Fax:614-645-5546
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2015-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHNM02979367A00000X
OHRN176314367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2400128Medicaid
OH316400223035OtherCARESOURCE CLINIC#
OHH274290Medicare PIN