MEDICARE: MRS. ROCHELLE KATHRYN WATKINS CNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0200X	Pediatric Nurse Practitioner	NP-07918	OH

General Provider Information

NPI Number	:	1508166109
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ROCHELLE KATHRYN WATKINS CNP

Provider Business Mailing Address
First Line	:	1483 W MAIN ST
Second Line	:
City	:	TIPP CITY
State	:	OH
Zip	:	45371-2803
Country	:	US
Telephone Number	:	937-667-7713
Fax Number	:	937-667-8067

Provider Business Practice Location Address
First Line	:	1483 W MAIN ST
Second Line	:
City	:	TIPP CITY
State	:	OH
Zip	:	45371-2803
Country	:	US
Telephone Number	:	937-667-7713
Fax Number	:	937-667-8067

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/28/2010
Last Update Date	:	10/28/2010

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