MEDICARE: MRS. DEBORAH KAY PERKINS FNP-BC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	2009003721	MO
2	363LF0000X	Family Nurse Practitioner	2015038036	MO

General Provider Information

NPI Number	:	1053776179
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. DEBORAH KAY PERKINS FNP-BC

Provider Business Mailing Address
First Line	:	10050 KENNERLY RD STE 2400
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63128-2193
Country	:	US
Telephone Number	:	314-849-6066
Fax Number	:

Provider Business Practice Location Address
First Line	:	10050 KENNERLY RD STE 2400
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63128-2193
Country	:	US
Telephone Number	:	314-849-6066
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/16/2015
Last Update Date	:	05/07/2024

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