1427139930 NPI number — MS. JACQUELINE WILLIAMSON ADKINS FNP

Table of content: MS. JACQUELINE WILLIAMSON ADKINS FNP (NPI 1427139930)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1427139930 NPI number — MS. JACQUELINE WILLIAMSON ADKINS FNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ADKINS
Provider First Name:
JACQUELINE
Provider Middle Name:
WILLIAMSON
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
FNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1427139930
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/12/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
P.O. BOX 262
Provider Second Line Business Mailing Address:
2756 MALMAISON ROAD
Provider Business Mailing Address City Name:
BLAIRS
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
24527-0262
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
434-793-3905
Provider Business Mailing Address Fax Number:
434-793-3905

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1040 MAIN ST
Provider Second Line Business Practice Location Address:
DANVILLE UROLOGIC CLINIC
Provider Business Practice Location Address City Name:
DANVILLE
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
24541-1816
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
434-792-1433
Provider Business Practice Location Address Fax Number:
434-797-2807
Provider Enumeration Date:
10/18/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  5004254 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LF0000X , with the licence number: 0024062191 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1427139930 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".




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