Provider Demographics
NPI:1598130114
Name:PERKINS, MICAELA DELASHMIT (BSN, RN, MSN, NP-C)
Entity Type:Individual
Prefix:MRS
First Name:MICAELA
Middle Name:DELASHMIT
Last Name:PERKINS
Suffix:
Gender:F
Credentials:BSN, RN, MSN, NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
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Mailing Address - Street 1:965 RIDGE LAKE BLVD STE 103
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38120-9446
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:901-227-8591
Practice Address - Street 1:504 AZALEA DR STE A
Practice Address - Street 2:
Practice Address - City:OXFORD
Practice Address - State:MS
Practice Address - Zip Code:38655-5397
Practice Address - Country:US
Practice Address - Phone:662-513-1766
Practice Address - Fax:662-513-1776
Is Sole Proprietor?:No
Enumeration Date:2015-12-08
Last Update Date:2021-06-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MSR892138163W00000X
MS901476363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse