Individual
MARISSA NICOLE PERKINS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
7950 W JEFFERSON BLVD, FORT WAYNE, IN 46804-4160
(260) 435-7001
Mailing address
1010 COLUMBIA AVE, FORT WAYNE, IN 46805-4310
(260) 388-4366
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
10004304A
IN
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0071483
—
OH
Enumeration date
12/20/2023
Last updated
08/21/2025
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