Healthcare Provider Details

I. General information

NPI: 1639770654
Provider Name (Legal Business Name): JULIE ANN SPINKS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/05/2020
Last Update Date: 05/04/2022
Certification Date: 05/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

99 MILL BRANCH RD
FENWICK WV
26202-4034
US

IV. Provider business mailing address

99 MILL BRANCH RD
FENWICK WV
26202-4034
US

V. Phone/Fax

Practice location:
  • Phone: 304-906-3978
  • Fax:
Mailing address:
  • Phone: 304-906-3978
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: