=====================================================
General NPI Number Information
=====================================================
NPI Number | 1689459067
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DANNY L SKINNER II
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/25/2023
-----------------------------------------------------
Last Update Date | 08/25/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4431 BUNKER HILL RD
-----------------------------------------------------
City | KESWICK
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22947-2414
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 434-327-8426
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4431 BUNKER HILL RD
-----------------------------------------------------
City | KESWICK
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22947-2414
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 434-327-6549
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 172A00000X
-----------------------------------------------------
Taxonomy Name | Driver
-----------------------------------------------------
License Number | A61261377
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------