Provider Demographics
NPI:1902945322
Name:PERKINS, JIMMYE SHANNON (MD)
Entity Type:Individual
Prefix:DR
First Name:JIMMYE
Middle Name:SHANNON
Last Name:PERKINS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1325
Mailing Address - Street 2:
Mailing Address - City:CORBIN
Mailing Address - State:KY
Mailing Address - Zip Code:40702-1325
Mailing Address - Country:US
Mailing Address - Phone:606-526-8131
Mailing Address - Fax:606-528-8661
Practice Address - Street 1:2 TRILLIUM WAY
Practice Address - Street 2:SUITE 306
Practice Address - City:CORBIN
Practice Address - State:KY
Practice Address - Zip Code:40701-8490
Practice Address - Country:US
Practice Address - Phone:606-526-4070
Practice Address - Fax:606-526-4072
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-05
Last Update Date:2020-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY41595208000000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100069560Medicaid
KYP01329695OtherRR MEDICARE
LAK063211Medicare PIN
KYP01329695OtherRR MEDICARE
TN3002489Medicare PIN