Provider Demographics
NPI:1134971153
Name:ADKINS, ROBERT SHANE
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:SHANE
Last Name:ADKINS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:245 LITTLE SPARROW ST
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:WV
Mailing Address - Zip Code:24740-7544
Mailing Address - Country:US
Mailing Address - Phone:276-928-6562
Mailing Address - Fax:
Practice Address - Street 1:114 GLENDALE LN
Practice Address - Street 2:
Practice Address - City:COOL RIDGE
Practice Address - State:WV
Practice Address - Zip Code:25825
Practice Address - Country:US
Practice Address - Phone:276-928-6562
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-03
Last Update Date:2024-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV3747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant