Provider Demographics
NPI:1548896335
Name:PERKINS, KEISHA SHAE (APRN)
Entity type:Individual
Prefix:MRS
First Name:KEISHA
Middle Name:SHAE
Last Name:PERKINS
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:421 W HIGHWAY 80
Mailing Address - Street 2:
Mailing Address - City:LONDON
Mailing Address - State:KY
Mailing Address - Zip Code:40741-1070
Mailing Address - Country:US
Mailing Address - Phone:606-657-2345
Mailing Address - Fax:606-657-2346
Practice Address - Street 1:421 W HIGHWAY 80
Practice Address - Street 2:
Practice Address - City:LONDON
Practice Address - State:KY
Practice Address - Zip Code:40741-1070
Practice Address - Country:US
Practice Address - Phone:606-657-2345
Practice Address - Fax:606-657-2346
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-12
Last Update Date:2024-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3014444207Q00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine