Provider Demographics
NPI:1366531204
Name:PERKINS, KENNETH B (PA)
Entity type:Individual
Prefix:
First Name:KENNETH
Middle Name:B
Last Name:PERKINS
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 90
Mailing Address - Street 2:
Mailing Address - City:MIDDLEBROOK
Mailing Address - State:VA
Mailing Address - Zip Code:24459-0090
Mailing Address - Country:US
Mailing Address - Phone:540-887-2627
Mailing Address - Fax:540-886-2726
Practice Address - Street 1:36 CHERRY GROVE ROAD
Practice Address - Street 2:
Practice Address - City:MIDDLEBROOK
Practice Address - State:VA
Practice Address - Zip Code:24459
Practice Address - Country:US
Practice Address - Phone:540-887-2627
Practice Address - Fax:540-886-2726
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2010-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0110002135363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAQ50346Medicare UPIN
VA008323U42Medicare ID - Type Unspecified