Provider Demographics
NPI:1003831017
Name:ADKINS, MARK J (ARNP)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:J
Last Name:ADKINS
Suffix:
Gender:M
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:305 SEATTLE SLEW DR
Mailing Address - Street 2:
Mailing Address - City:MILTON
Mailing Address - State:WV
Mailing Address - Zip Code:25541-9570
Mailing Address - Country:US
Mailing Address - Phone:304-710-9077
Mailing Address - Fax:
Practice Address - Street 1:3983 TEAYS VALLEY RD STE G1
Practice Address - Street 2:
Practice Address - City:HURRICANE
Practice Address - State:WV
Practice Address - Zip Code:25526-8863
Practice Address - Country:US
Practice Address - Phone:844-523-2273
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-12
Last Update Date:2020-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV58878363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100050800Medicaid
OH2667056Medicaid
OH2667056Medicaid
WVNP21211Medicare PIN
WVNP21215Medicare PIN
KY00788005Medicare PIN
WVNP21213Medicare PIN
WVQ70610Medicare UPIN