Provider Demographics
NPI:1831907047
Name:ADKINS, TANYA RENEA
Entity type:Individual
Prefix:
First Name:TANYA
Middle Name:RENEA
Last Name:ADKINS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:355 BIG BRANCH RD
Mailing Address - Street 2:
Mailing Address - City:WAYNE
Mailing Address - State:WV
Mailing Address - Zip Code:25570-9417
Mailing Address - Country:US
Mailing Address - Phone:304-638-9165
Mailing Address - Fax:
Practice Address - Street 1:355 BIG BRANCH RD
Practice Address - Street 2:
Practice Address - City:WAYNE
Practice Address - State:WV
Practice Address - Zip Code:25570-9417
Practice Address - Country:US
Practice Address - Phone:304-638-9165
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-19
Last Update Date:2024-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV64567163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health