Provider Demographics
NPI:1649846791
Name:PERKINS, ANGELA MARICE (FNP-C)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:MARICE
Last Name:PERKINS
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:444 N PLEASANT HILL RD
Mailing Address - Street 2:
Mailing Address - City:NEWHEBRON
Mailing Address - State:MS
Mailing Address - Zip Code:39140-4010
Mailing Address - Country:US
Mailing Address - Phone:601-695-8270
Mailing Address - Fax:
Practice Address - Street 1:910 SECOND ST
Practice Address - Street 2:
Practice Address - City:PRENTISS
Practice Address - State:MS
Practice Address - Zip Code:39474-9117
Practice Address - Country:US
Practice Address - Phone:601-792-2078
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-31
Last Update Date:2021-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS904653363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily