Healthcare Provider Details

I. General information

NPI: 1902058506
Provider Name (Legal Business Name): DUSTIN MILES ADKINS PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/15/2008
Last Update Date: 06/03/2020
Certification Date: 06/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 SAINT CHRISTOPHER DR STE 1
ASHLAND KY
41101-7030
US

IV. Provider business mailing address

PO BOX 2379
ASHLAND KY
41105-2379
US

V. Phone/Fax

Practice location:
  • Phone: 606-836-9613
  • Fax: 606-836-0026
Mailing address:
  • Phone: 606-408-4000
  • Fax: 606-408-7425

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA1139
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: