Individual
REVA HACKNEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
121 COURT ST S, RIPLEY, WV 25271-1408
(304) 372-2406
Mailing address
PO BOX 617, RIPLEY, WV 25271-0617
Taxonomy
Speciality
Code
Description
License number
State
376J00000X
Homemaker
Primary
—
—
Other
Enumeration date
02/22/2021
Last updated
02/22/2021
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