Provider Demographics
NPI:1942772728
Name:PERKINS, MYA TUESDAY (RD)
Entity Type:Individual
Prefix:
First Name:MYA
Middle Name:TUESDAY
Last Name:PERKINS
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:MYA
Other - Middle Name:TUESDAY
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD
Mailing Address - Street 1:410 E 9TH AVE APT 10
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85204-4141
Mailing Address - Country:US
Mailing Address - Phone:602-733-7509
Mailing Address - Fax:
Practice Address - Street 1:1920 N HIGLEY RD STE 306
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85234-1625
Practice Address - Country:US
Practice Address - Phone:480-543-2606
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-18
Last Update Date:2019-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133N00000XDietary & Nutritional Service ProvidersNutritionist
No133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education