Healthcare Provider Details

I. General information

NPI: 1750598223
Provider Name (Legal Business Name): KRISTY WATKINS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/16/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

510 29.5 RD
GRAND JUNCTION CO
81504
US

IV. Provider business mailing address

510 29.5 RD
GRAND JUNCTION CO
81504
US

V. Phone/Fax

Practice location:
  • Phone: 970-248-6933
  • Fax: 970-248-6913
Mailing address:
  • Phone: 970-248-6933
  • Fax: 970-248-6913

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License NumberRN-166979
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: