Provider Demographics
NPI:1982635892
Name:PERKINS, LAURA BIRDWELL (NP)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:BIRDWELL
Last Name:PERKINS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8001 YOUREE DR
Mailing Address - Street 2:SUITE 450
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71115-2302
Mailing Address - Country:US
Mailing Address - Phone:318-212-3952
Mailing Address - Fax:318-212-3955
Practice Address - Street 1:8001 YOUREE DR
Practice Address - Street 2:SUITE 450
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71115-2302
Practice Address - Country:US
Practice Address - Phone:318-212-3952
Practice Address - Fax:318-212-3955
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2007-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP03100363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1559318Medicaid
LA5X620Medicare PIN
S65192Medicare UPIN
LA1559318Medicaid