Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LC0200X | Nurse Practitioner - Critical Care Medicine | AP144030 | TX |
NPI | 1043841687 |
---|---|
Provider Name | Russell Perkins |
First Address | Katy, TX 77494-2867 |
Second Address | Houston, TX 77030-1501 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/02/2020 |
Last Update Date | 02/02/2020 |