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General NPI Number Information
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NPI Number | 1750419966
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Entity Type | Individual
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Provider Name | JACLYN LEA ADKINS PA
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Gender | Female
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Dates
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Enumeration Date | 03/01/2007
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Last Update Date | 07/14/2011
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Provider Practice Location Address
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Address Line | 645 KANAWHA AVE
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City | RAINELLE
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State | WV
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Zip | 25962-1013
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Country | US
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Telephone | 304-438-6188
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Fax | 304-438-6819
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Provider Business Mailing Address
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Address Line | HC 30 BOX 56
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City | CALDWELL
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State | WV
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Zip | 24925
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Country | US
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Telephone | 304-645-1463
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 00866
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License Number State | WV
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