Healthcare Provider Details

I. General information

NPI: 1619506870
Provider Name (Legal Business Name): RACHELLE BREANNE PERKINS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: RACHELLE ROBERTS

II. Dates (important events)

Enumeration Date: 04/08/2020
Last Update Date: 05/28/2024
Certification Date: 05/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5121 S COTTONWOOD ST
MURRAY UT
84107-5701
US

IV. Provider business mailing address

20 YORK ST TOMPKINS 226
NEW HAVEN CT
06510-3220
US

V. Phone/Fax

Practice location:
  • Phone: 801-507-7000
  • Fax:
Mailing address:
  • Phone: 203-688-4242
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number13621053-1205
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: