Healthcare Provider Details

I. General information

NPI: 1770954513
Provider Name (Legal Business Name): BRIAN PERKINS NP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/19/2015
Last Update Date: 02/20/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 CITYPLACE DR
SAINT LOUIS MO
63141-7014
US

IV. Provider business mailing address

1 CITYPLACE DR
SAINT LOUIS MO
63141-7014
US

V. Phone/Fax

Practice location:
  • Phone: 314-514-6000
  • Fax:
Mailing address:
  • Phone: 314-514-6000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAG1015111
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number2008000393
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: