Basic Information
| Provider Information | |||||||||
| NPI: | 1760425748 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PERKINS | ||||||||
| FirstName: | MELISSA | ||||||||
| MiddleName: | A | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | PA-C | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | RODGERS | ||||||||
| OtherFirstName: | MELISSA | ||||||||
| OtherMiddleName: | A | ||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | PA-C | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 131 SAUNDERSVILLE RD | ||||||||
| Address2: | STE 160 | ||||||||
| City: | HENDERSONVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 37075 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6158243737 | ||||||||
| FaxNumber: | 8882950304 | ||||||||
| Practice Location | |||||||||
| Address1: | 353 NEW SHACKLE ISLAND RD | ||||||||
| Address2: | STE 122B | ||||||||
| City: | HENDERSONVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 370752379 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6158243737 | ||||||||
| FaxNumber: | 8882950304 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/14/2006 | ||||||||
| LastUpdateDate: | 07/10/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | PA0000001099 | TN | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | 363A00000X | 004869 | GA | N | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
ID Information
| ID | Type | State | Issuer | Description | 3662051 | 05 | TN | MEDICAID | 4118930 | 01 | TN | BCBSTN | OTHER |