Provider Demographics
NPI:1407656721
Name:PLUNKETT, ADRIAN DESHA
Entity type:Individual
Prefix:MR
First Name:ADRIAN
Middle Name:DESHA
Last Name:PLUNKETT
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:640 KENTUCK CHURCH RD
Mailing Address - Street 2:
Mailing Address - City:RINGGOLD
Mailing Address - State:VA
Mailing Address - Zip Code:24586-5136
Mailing Address - Country:US
Mailing Address - Phone:434-770-8349
Mailing Address - Fax:434-770-8349
Practice Address - Street 1:640 KENTUCK CHURCH RD
Practice Address - Street 2:
Practice Address - City:RINGGOLD
Practice Address - State:VA
Practice Address - Zip Code:24586-5136
Practice Address - Country:US
Practice Address - Phone:434-770-8349
Practice Address - Fax:434-770-8349
Is Sole Proprietor?:No
Enumeration Date:2025-03-17
Last Update Date:2025-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA1799172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver