Healthcare Provider Details

I. General information

NPI: 1811405236
Provider Name (Legal Business Name): TODD M PERKINS CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/19/2018
Last Update Date: 03/06/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 NORTHCREST DR
SPRINGFIELD TN
37172
US

IV. Provider business mailing address

3340 PLAYERS CLUB PKWY STE 350
MEMPHIS TN
38125-8949
US

V. Phone/Fax

Practice location:
  • Phone: 615-384-1529
  • Fax: 615-384-1765
Mailing address:
  • Phone: 901-844-1590
  • Fax: 901-844-1592

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number25500
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAPRN.CRNA.019618
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: