Healthcare Provider Details

I. General information

NPI: 1003538836
Provider Name (Legal Business Name): BRYNN PERKINS PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/19/2022
Last Update Date: 01/29/2025
Certification Date: 01/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

535 NW 9TH ST STE 235
OKLAHOMA CITY OK
73102-1078
US

IV. Provider business mailing address

3525 YUCCA DR
EDMOND OK
73013-7902
US

V. Phone/Fax

Practice location:
  • Phone: 405-772-4338
  • Fax: 405-772-4339
Mailing address:
  • Phone: 405-496-7726
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number4859
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: