Healthcare Provider Details

I. General information

NPI: 1366163107
Provider Name (Legal Business Name): PENNY LEONE PERKINS FNP-BC, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/09/2022
Last Update Date: 09/27/2022
Certification Date: 09/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16158 AIRLINE HWY STE 103
PRAIRIEVILLE LA
70769-4222
US

IV. Provider business mailing address

8009 BOARD DR
BATON ROUGE LA
70817-6050
US

V. Phone/Fax

Practice location:
  • Phone: 225-963-9355
  • Fax: 225-314-9355
Mailing address:
  • Phone: 225-614-5030
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number227104
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: