Healthcare Provider Details

I. General information

NPI: 1558751107
Provider Name (Legal Business Name): KAYLA LEIGH ASHLEY PERKINS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/03/2015
Last Update Date: 10/12/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5001 HARDY ST
HATTIESBURG MS
39402-1308
US

IV. Provider business mailing address

7100 HIGHWAY 98 WEST SUITE 140
HATTIESBURG MS
39402-8557
US

V. Phone/Fax

Practice location:
  • Phone: 601-268-8000
  • Fax:
Mailing address:
  • Phone: 601-450-8822
  • Fax: 601-450-8821

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR879751
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: