Provider Demographics
NPI:1417598608
Name:PERKINSON, BRANDY WILSON
Entity Type:Individual
Prefix:
First Name:BRANDY
Middle Name:WILSON
Last Name:PERKINSON
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 1:11006 QUAKER RD
Mailing Address - Street 2:
Mailing Address - City:DINWIDDIE
Mailing Address - State:VA
Mailing Address - Zip Code:23841-3022
Mailing Address - Country:US
Mailing Address - Phone:804-894-2212
Mailing Address - Fax:
Practice Address - Street 1:11006 QUAKER RD
Practice Address - Street 2:
Practice Address - City:DINWIDDIE
Practice Address - State:VA
Practice Address - Zip Code:23841-3022
Practice Address - Country:US
Practice Address - Phone:804-894-2212
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-30
Last Update Date:2019-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider