MEDICARE: ANDREA PERKINS

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	282N00000X	General Acute Care Hospital	R091253	AR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	R091253	OTHER	AR	ARKANSAS STATE BOARD OF NURSING

General Provider Information

NPI Number	:	1629455662
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANDREA PERKINS

Provider Business Mailing Address
First Line	:	118 ESSEX ST
Second Line	:
City	:	HOT SPRINGS
State	:	AR
Zip	:	71913-5845
Country	:	US
Telephone Number	:	501-463-7792
Fax Number	:

Provider Business Practice Location Address
First Line	:	118 ESSEX ST
Second Line	:
City	:	HOT SPRINGS
State	:	AR
Zip	:	71913-5845
Country	:	US
Telephone Number	:	501-463-7792
Fax Number	:

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

Provider Enumeration Date	:	04/29/2015
Last Update Date	:	04/29/2015

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