MEDICARE: MRS. JAYNE LENOR PERKINS APN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	542600	TX
2	363LG0600X	Gerontology Nurse Practitioner	542600	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	889N77	OTHER	TX	BC/BS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1952412132
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JAYNE LENOR PERKINS APN

Provider Business Mailing Address
First Line	:	2605 POTOMAC DR
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77057-4529
Country	:	US
Telephone Number	:	713-784-1260
Fax Number	:

Provider Business Practice Location Address
First Line	:	2605 POTOMAC DR
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77057-4529
Country	:	US
Telephone Number	:	713-784-1260
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/31/2006
Last Update Date	:	08/20/2013

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