Provider Demographics
NPI:1386300507
Name:PERKINS, OLIN NICHOLAS (PA-C)
Entity type:Individual
Prefix:
First Name:OLIN
Middle Name:NICHOLAS
Last Name:PERKINS
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2090 WALLUM LAKE RD
Mailing Address - Street 2:
Mailing Address - City:PASCOAG
Mailing Address - State:RI
Mailing Address - Zip Code:02859-1813
Mailing Address - Country:US
Mailing Address - Phone:401-567-5400
Mailing Address - Fax:
Practice Address - Street 1:2090 WALLUM LAKE RD
Practice Address - Street 2:
Practice Address - City:PASCOAG
Practice Address - State:RI
Practice Address - Zip Code:02859-1813
Practice Address - Country:US
Practice Address - Phone:401-567-5400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-11
Last Update Date:2025-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY030779363A00000X
CA63170363A00000X
OH50.008492RX363A00000X
RIPA01645363A00000X
PAMA063251363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant