Basic Information
| Provider Information | |||||||||
| NPI: | 1750419966 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ADKINS | ||||||||
| FirstName: | JACLYN | ||||||||
| MiddleName: | LEA | ||||||||
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| Credential: | PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | HC 30 BOX 56 | ||||||||
| Address2: | |||||||||
| City: | CALDWELL | ||||||||
| State: | WV | ||||||||
| PostalCode: | 24925 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3046451463 | ||||||||
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| Practice Location | |||||||||
| Address1: | 645 KANAWHA AVE | ||||||||
| Address2: | |||||||||
| City: | RAINELLE | ||||||||
| State: | WV | ||||||||
| PostalCode: | 259621013 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3044386188 | ||||||||
| FaxNumber: | 3044386819 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/01/2007 | ||||||||
| LastUpdateDate: | 07/14/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | 00866 | WV | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.