Provider Demographics
NPI:1093730624
Name:EAKLE, LINDA ANN (DO)
Entity Type:Individual
Prefix:DR
First Name:LINDA
Middle Name:ANN
Last Name:EAKLE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1509 W MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:MILTON
Mailing Address - State:WV
Mailing Address - Zip Code:25541
Mailing Address - Country:US
Mailing Address - Phone:304-743-7141
Mailing Address - Fax:304-743-7143
Practice Address - Street 1:1509 W MAIN STREET
Practice Address - Street 2:
Practice Address - City:MILTON
Practice Address - State:WV
Practice Address - Zip Code:25541
Practice Address - Country:US
Practice Address - Phone:304-743-7141
Practice Address - Fax:304-743-7143
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2015-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVWV0792207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0050180000Medicaid
WV0050180000Medicaid
WV0050180000Medicaid