Provider Demographics
NPI:1225163744
Name:PERKINS, JUANITA CONSUELA (FNP-BC)
Entity Type:Individual
Prefix:
First Name:JUANITA
Middle Name:CONSUELA
Last Name:PERKINS
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1707 AUTUMN RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27712-4601
Mailing Address - Country:US
Mailing Address - Phone:919-943-9515
Mailing Address - Fax:866-788-7843
Practice Address - Street 1:3209 GUESS RD STE 108
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27705-2692
Practice Address - Country:US
Practice Address - Phone:919-748-3668
Practice Address - Fax:866-788-7843
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-23
Last Update Date:2020-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200599163W00000X
NY334577363LF0000X
NC5001612363LF0000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7004483Medicaid