Provider Demographics
NPI:1629176540
Name:ADKINS, KENNETH (DO)
Entity Type:Individual
Prefix:
First Name:KENNETH
Middle Name:
Last Name:ADKINS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4700 LYNN AVE
Mailing Address - Street 2:
Mailing Address - City:HAMLIN
Mailing Address - State:WV
Mailing Address - Zip Code:25523-1138
Mailing Address - Country:US
Mailing Address - Phone:304-824-5806
Mailing Address - Fax:304-824-5804
Practice Address - Street 1:1563 SAND PLANT RD
Practice Address - Street 2:
Practice Address - City:SOUTH CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25309-6120
Practice Address - Country:US
Practice Address - Phone:304-756-1500
Practice Address - Fax:304-756-1549
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2016-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV2063207P00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV2063OtherLICENSE
WV3810006146Medicaid
WV001886032OtherHIGHMARK BCBS
WVWV2437CMedicare Oscar/Certification
WVWV2437DMedicare Oscar/Certification
WVWV2437FMedicare Oscar/Certification
WVWV2437B662Medicare Oscar/Certification
WV2063OtherLICENSE
WV3810006146Medicaid
WVWV2437B663Medicare Oscar/Certification
WVWV2437AMedicare Oscar/Certification
WVWV2437EMedicare Oscar/Certification
WVWV2437GMedicare Oscar/Certification