Most Relevant Information
Provider Data
| NPI Number: | 1003420167 |
| Provider Name: | TINA MICHELLE PROUT |
| Entity Type: | Individual |
| Taxonomy Code: | 3747P1801X |
| Specialty: | Technician |
| License Number: |
Most Important Dates
| Enumeration Date: | 09/04/2020 |
| Last Updated: | 06/24/2021 |
Provider Practice Location
814 24TH ST
HUNTINGTON
WV
257031948
Practice Location Phone/Fax
| Phone: | 3046544337 |
| Fax: |
Provider Mailing Location
814 24TH ST
HUNTINGTON
WV
257031948
Provider Mailing Phone/Fax
| Phone: | 3046544337 |
| Fax: |