Provider Demographics
NPI:1396402863
Name:ADKINS, HAVILAH REY (APRN)
Entity Type:Individual
Prefix:DR
First Name:HAVILAH
Middle Name:REY
Last Name:ADKINS
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:HAVILAH
Other - Middle Name:REY
Other - Last Name:CHOWDHURY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:400 UNIVERSITY DR STE 101
Mailing Address - Street 2:
Mailing Address - City:PRESTONSBURG
Mailing Address - State:KY
Mailing Address - Zip Code:41653-1080
Mailing Address - Country:US
Mailing Address - Phone:606-886-1173
Mailing Address - Fax:
Practice Address - Street 1:400 UNIVERSITY DR STE 101
Practice Address - Street 2:
Practice Address - City:PRESTONSBURG
Practice Address - State:KY
Practice Address - Zip Code:41653-1080
Practice Address - Country:US
Practice Address - Phone:606-886-1173
Practice Address - Fax:606-886-2193
Is Sole Proprietor?:No
Enumeration Date:2021-11-19
Last Update Date:2021-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3016395363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY3016395OtherNURSE PRACTICIONER