Provider Demographics
NPI:1740477207
Name:PERKINS, SHAWNIE RENEE (MSPAS, PA-C)
Entity type:Individual
Prefix:MRS
First Name:SHAWNIE
Middle Name:RENEE
Last Name:PERKINS
Suffix:
Gender:F
Credentials:MSPAS, PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1824 PEDEN BRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:CHESTER
Mailing Address - State:SC
Mailing Address - Zip Code:29706-3720
Mailing Address - Country:US
Mailing Address - Phone:803-412-6696
Mailing Address - Fax:
Practice Address - Street 1:1012 MARKET ST STE 301
Practice Address - Street 2:
Practice Address - City:FORT MILL
Practice Address - State:SC
Practice Address - Zip Code:29708-6537
Practice Address - Country:US
Practice Address - Phone:803-881-9990
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-28
Last Update Date:2019-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA19382363A00000X
NC0010-01813363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1740477207Medicaid