Provider Demographics
NPI:1609982966
Name:PERKINS, KIMBERLY (AUD)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:
Last Name:PERKINS
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1128 N LAURA ST
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32206-4912
Mailing Address - Country:US
Mailing Address - Phone:904-355-3403
Mailing Address - Fax:904-355-4149
Practice Address - Street 1:1128 N LAURA ST
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32206-4912
Practice Address - Country:US
Practice Address - Phone:904-355-3403
Practice Address - Fax:904-355-4149
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2015-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAY1734231H00000X
IL237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Not Answered237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL147-000679OtherSTATE LICENSE #
05700224OtherBLUE CROSS BLUE SHIELD
FL011817500Medicaid