Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2100X | Nurse Practitioner - Acute Care | 58878 | WV |
NPI | 1003831017 |
---|---|
Provider Name | Mark J Adkins |
First Address | Milton, WV 25541-9570 |
Second Address | Hurricane, WV 25526-8863 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/07/2006 |
Last Update Date | 13/01/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2667056 | (05) | OH |
7100050800 | (05) | KY |
Q70610 | (02) | WV |