Healthcare Provider Details

I. General information

NPI: 1497805725
Provider Name (Legal Business Name): ALICE PAULINE WATKINS FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/11/2007
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

108 E HOSPITAL DR
WINCHESTER IN
47394-2223
US

IV. Provider business mailing address

108 E HOSPITAL DR
WINCHESTER IN
47394-2223
US

V. Phone/Fax

Practice location:
  • Phone: 765-584-1639
  • Fax: 765-584-4711
Mailing address:
  • Phone: 765-584-1639
  • Fax: 765-584-4711

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number71001624A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: