Provider Demographics
NPI:1285655605
Name:ADKINS, DEAN (PA)
Entity type:Individual
Prefix:
First Name:DEAN
Middle Name:
Last Name:ADKINS
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108 CEDAR GREEN DR
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MS
Mailing Address - Zip Code:39046-3367
Mailing Address - Country:US
Mailing Address - Phone:601-826-8923
Mailing Address - Fax:205-313-5245
Practice Address - Street 1:830 S GLOSTER ST
Practice Address - Street 2:
Practice Address - City:TUPELO
Practice Address - State:MS
Practice Address - Zip Code:38801-4934
Practice Address - Country:US
Practice Address - Phone:866-754-3852
Practice Address - Fax:205-313-5245
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2009-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSPA065363AM0700X
MSPA00065207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS01027725Medicaid
LA1452033Medicaid
MSQ23457Medicare UPIN
MS01027725Medicaid