Healthcare Provider Details

I. General information

NPI: 1811272172
Provider Name (Legal Business Name): KATIE F PERKINS RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/19/2011
Last Update Date: 10/19/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

516 E NIZHONI BLVD
GALLUP NM
87301-5748
US

IV. Provider business mailing address

516 E NIZHONI BLVD
GALLUP NM
87301-5748
US

V. Phone/Fax

Practice location:
  • Phone: 505-722-1513
  • Fax: 505-722-1487
Mailing address:
  • Phone: 505-722-1513
  • Fax: 505-722-1487

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN234505
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: