Provider Demographics
NPI:1093476061
Name:AKINS, TARA LEA
Entity Type:Individual
Prefix:
First Name:TARA
Middle Name:LEA
Last Name:AKINS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5163 CLEAR FORK RD
Mailing Address - Street 2:
Mailing Address - City:ARTIE
Mailing Address - State:WV
Mailing Address - Zip Code:25008-9522
Mailing Address - Country:US
Mailing Address - Phone:681-400-3236
Mailing Address - Fax:
Practice Address - Street 1:5163 CLEAR FORK RD
Practice Address - Street 2:
Practice Address - City:ARTIE
Practice Address - State:WV
Practice Address - Zip Code:25008-9522
Practice Address - Country:US
Practice Address - Phone:681-400-3236
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-03
Last Update Date:2022-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant