Healthcare Provider Details

I. General information

NPI: 1174775209
Provider Name (Legal Business Name): TERESA MADIGAN WATKINS NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/21/2008
Last Update Date: 10/21/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 E SOUTH BLVD
MONTGOMERY AL
36116-2317
US

IV. Provider business mailing address

1301 E SOUTH BLVD
MONTGOMERY AL
36116-2317
US

V. Phone/Fax

Practice location:
  • Phone: 334-281-8008
  • Fax: 334-281-0090
Mailing address:
  • Phone: 334-281-8008
  • Fax: 334-281-0090

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number1-033429
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: