Healthcare Provider Details

I. General information

NPI: 1831907047
Provider Name (Legal Business Name): TANYA RENEA ADKINS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/19/2024
Last Update Date: 12/19/2024
Certification Date: 12/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

355 BIG BRANCH RD
WAYNE WV
25570-9417
US

IV. Provider business mailing address

355 BIG BRANCH RD
WAYNE WV
25570-9417
US

V. Phone/Fax

Practice location:
  • Phone: 304-638-9165
  • Fax:
Mailing address:
  • Phone: 304-638-9165
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License Number64567
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: