Provider Demographics
NPI:1851607626
Name:PERKINS, KIMBERLY J (PA-C)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:J
Last Name:PERKINS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:KIMBERLY
Other - Middle Name:J
Other - Last Name:MARQUARDT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:15 ENTERPRISE DR
Mailing Address - Street 2:STE 100
Mailing Address - City:AUGUSTA
Mailing Address - State:ME
Mailing Address - Zip Code:04330-7894
Mailing Address - Country:US
Mailing Address - Phone:207-621-8700
Mailing Address - Fax:207-621-8701
Practice Address - Street 1:15 ENTERPRISE DR
Practice Address - Street 2:STE 100
Practice Address - City:AUGUSTA
Practice Address - State:ME
Practice Address - Zip Code:04330-7894
Practice Address - Country:US
Practice Address - Phone:207-621-8700
Practice Address - Fax:207-621-8701
Is Sole Proprietor?:No
Enumeration Date:2010-08-31
Last Update Date:2011-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPA001234363A00000X, 363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME1851607626Medicaid
ME001811701Medicare PIN