Healthcare Provider Details

I. General information

NPI: 1396484721
Provider Name (Legal Business Name): AMBER R WATKINS RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/02/2022
Last Update Date: 06/02/2022
Certification Date: 06/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

748 N 66TH WAY
MESA AZ
85205-6847
US

IV. Provider business mailing address

748 N 66TH WAY
MESA AZ
85205-6847
US

V. Phone/Fax

Practice location:
  • Phone: 931-632-0535
  • Fax:
Mailing address:
  • Phone: 931-632-0535
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License NumberRN178903
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code163WN1003X
TaxonomyNutrition Support Registered Nurse
License NumberRN178903
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: