Healthcare Provider Details

I. General information

NPI: 1871621508
Provider Name (Legal Business Name): NAN E PERKINS RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MRS. NAN E BOOKHOUT

II. Dates (important events)

Enumeration Date: 03/02/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5500 E KELLOGG DR
WICHITA KS
67218-1607
US

IV. Provider business mailing address

533 S. CHAUTAUQUA ST.
WICHITA KS
67211
US

V. Phone/Fax

Practice location:
  • Phone: 316-651-3648
  • Fax:
Mailing address:
  • Phone: 316-612-7202
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WM0705X
TaxonomyMedical-Surgical Registered Nurse
License Number13100141061
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: