Provider Demographics
NPI:1376972406
Name:PERKINS, OREAL (N P)
Entity Type:Individual
Prefix:
First Name:OREAL
Middle Name:
Last Name:PERKINS
Suffix:
Gender:F
Credentials:N P
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17511 WISDOM DR
Mailing Address - Street 2:
Mailing Address - City:BAKER
Mailing Address - State:LA
Mailing Address - Zip Code:70714-1527
Mailing Address - Country:US
Mailing Address - Phone:225-335-2980
Mailing Address - Fax:225-306-1570
Practice Address - Street 1:17511 WISDOM DR
Practice Address - Street 2:
Practice Address - City:BAKER
Practice Address - State:LA
Practice Address - Zip Code:70714-1527
Practice Address - Country:US
Practice Address - Phone:225-335-2980
Practice Address - Fax:225-306-1570
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-08
Last Update Date:2017-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP07589363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2425773Medicaid