Provider Demographics
NPI:1407488216
Name:PERKINS, KECIA MCGOWEN
Entity Type:Individual
Prefix:
First Name:KECIA
Middle Name:MCGOWEN
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 1:214 BAY POINT PL
Mailing Address - Street 2:
Mailing Address - City:GAUTIER
Mailing Address - State:MS
Mailing Address - Zip Code:39553-6244
Mailing Address - Country:US
Mailing Address - Phone:228-218-2412
Mailing Address - Fax:
Practice Address - Street 1:75 WISCONSIN LOOP
Practice Address - Street 2:
Practice Address - City:PASCAGOULA
Practice Address - State:MS
Practice Address - Zip Code:39568
Practice Address - Country:US
Practice Address - Phone:228-935-8861
Practice Address - Fax:228-935-0161
Is Sole Proprietor?:No
Enumeration Date:2020-02-10
Last Update Date:2020-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSPT2854225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MSPT2854OtherPRIVATE INSURANCE