Individual
MRS. CHARLYNN S. PERKES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
495 YELLOWSTONE AVE, PHYSICIANS IMMEDIATE CARE CENTER, POCATELLO, ID 83201
(208) 478-7422
(208) 478-1515
Mailing address
1067 W 125 S, BLACKFOOT, ID 83221-6058
(208) 313-7226
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PENDING
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PENDING
STATE LICENSE PENDING
ID
Enumeration date
12/24/2007
Last updated
12/24/2007
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