Provider Demographics
NPI:1831596998
Name:PERKINS, REGINA (PA)
Entity type:Individual
Prefix:MRS
First Name:REGINA
Middle Name:
Last Name:PERKINS
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:721 E HOLLY ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:DEMING
Mailing Address - State:NM
Mailing Address - Zip Code:88030-5245
Mailing Address - Country:US
Mailing Address - Phone:575-546-6010
Mailing Address - Fax:575-546-4099
Practice Address - Street 1:721 E HOLLY ST
Practice Address - Street 2:SUITE B
Practice Address - City:DEMING
Practice Address - State:NM
Practice Address - Zip Code:88030-5245
Practice Address - Country:US
Practice Address - Phone:575-546-6010
Practice Address - Fax:575-546-4099
Is Sole Proprietor?:No
Enumeration Date:2014-12-04
Last Update Date:2015-06-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NMPA2014-0078363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant