Provider Demographics
NPI:1487256673
Name:MCCONNELL, EARON LYNETTE
Entity type:Individual
Prefix:
First Name:EARON
Middle Name:LYNETTE
Last Name:MCCONNELL
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 1:124 W C ST
Mailing Address - Street 2:
Mailing Address - City:BECKLEY
Mailing Address - State:WV
Mailing Address - Zip Code:25801-5503
Mailing Address - Country:US
Mailing Address - Phone:681-220-3548
Mailing Address - Fax:
Practice Address - Street 1:337 JASPER DR
Practice Address - Street 2:
Practice Address - City:BECKLEY
Practice Address - State:WV
Practice Address - Zip Code:25801-2502
Practice Address - Country:US
Practice Address - Phone:681-220-3548
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-12
Last Update Date:2020-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant