Provider Demographics
NPI:1558545624
Name:PERKES, CHARLYNN S (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:CHARLYNN
Middle Name:S
Last Name:PERKES
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1067 W 125 S
Mailing Address - Street 2:
Mailing Address - City:BLACKFOOT
Mailing Address - State:ID
Mailing Address - Zip Code:83221-6058
Mailing Address - Country:US
Mailing Address - Phone:208-313-7226
Mailing Address - Fax:
Practice Address - Street 1:495 YELLOWSTONE AVE
Practice Address - Street 2:PHYSICIANS IMMEDIATE CARE CENTER
Practice Address - City:POCATELLO
Practice Address - State:ID
Practice Address - Zip Code:83201
Practice Address - Country:US
Practice Address - Phone:208-478-7422
Practice Address - Fax:208-478-1515
Is Sole Proprietor?:No
Enumeration Date:2007-12-24
Last Update Date:2007-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDPENDING363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
IDPENDINGOtherSTATE LICENSE PENDING