Provider Demographics
NPI:1235642398
Name:PERKINS, GENILA MARIE
Entity Type:Individual
Prefix:MRS
First Name:GENILA
Middle Name:MARIE
Last Name:PERKINS
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:GENILA
Other - Middle Name:MARIE
Other - Last Name:SWEENEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 67
Mailing Address - Street 2:RT. 16 WARRIORMINE RD.
Mailing Address - City:WARRIORMINE
Mailing Address - State:WV
Mailing Address - Zip Code:24894
Mailing Address - Country:US
Mailing Address - Phone:304-875-3251
Mailing Address - Fax:
Practice Address - Street 1:1181 WARRIORMINE ROAD
Practice Address - Street 2:
Practice Address - City:WARRIORMINE
Practice Address - State:WV
Practice Address - Zip Code:24891
Practice Address - Country:US
Practice Address - Phone:304-875-3251
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-13
Last Update Date:2017-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVG229031420003747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WVG22903142000Medicaid