Provider Demographics
NPI:1720067556
Name:PERKINS, GAYLE L (PAC)
Entity Type:Individual
Prefix:MRS
First Name:GAYLE
Middle Name:L
Last Name:PERKINS
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:505 S BURG ST
Mailing Address - Street 2:
Mailing Address - City:KIMBALL
Mailing Address - State:NE
Mailing Address - Zip Code:69145
Mailing Address - Country:US
Mailing Address - Phone:308-235-1966
Mailing Address - Fax:308-235-2403
Practice Address - Street 1:505 S BURG ST
Practice Address - Street 2:
Practice Address - City:KIMBALL
Practice Address - State:NE
Practice Address - Zip Code:69145
Practice Address - Country:US
Practice Address - Phone:308-235-1966
Practice Address - Fax:308-235-2403
Is Sole Proprietor?:No
Enumeration Date:2006-01-11
Last Update Date:2010-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NENE411363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NENE411Medicaid
R80754Medicare UPIN
271757PEMedicare ID - Type Unspecified