=====================================================
General NPI Number Information
=====================================================
NPI Number | 1386609568
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JUANITA FRAZIER PERKINS FNP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/19/2006
-----------------------------------------------------
Last Update Date | 02/13/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 810 ELM ST
-----------------------------------------------------
City | FAYETTEVILLE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28303-4152
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 910-491-1089
-----------------------------------------------------
Fax | 833-973-5477
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 810 ELM ST
-----------------------------------------------------
City | FAYETTEVILLE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28303-4152
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 910-491-1089
-----------------------------------------------------
Fax | 833-973-5477
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363L00000X
-----------------------------------------------------
Taxonomy Name | Nurse Practitioner
-----------------------------------------------------
License Number | RN085691
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------