Healthcare Provider Details

I. General information

NPI: 1245254085
Provider Name (Legal Business Name): MRS. ALICIA DAWN AKERS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/26/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4280 COUNTY ROAD 41 N
PEDRO OH
45659-8502
US

IV. Provider business mailing address

4280 COUNTY ROAD 41 N
PEDRO OH
45659-8502
US

V. Phone/Fax

Practice location:
  • Phone: 740-643-2258
  • Fax: 740-643-2293
Mailing address:
  • Phone: 740-643-2258
  • Fax: 740-643-2293

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number2395064
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: