Healthcare Provider Details

I. General information

NPI: 1376501916
Provider Name (Legal Business Name): MRS. JAMIE KAY ADKINS
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/03/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 EAST MCDONALD AVENUE
MAN WV
25635-1097
US

IV. Provider business mailing address

600 EAST MCDONALD AVENUE
MAN WV
25635-1097
US

V. Phone/Fax

Practice location:
  • Phone: 304-583-6541
  • Fax: 304-583-6018
Mailing address:
  • Phone: 304-583-6541
  • Fax: 304-583-6018

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number2173
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: