Healthcare Provider Details

I. General information

NPI: 1487576252
Provider Name (Legal Business Name): KATELYNN MARIE WATKINS RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/27/2026
Last Update Date: 07/27/2026
Certification Date: 07/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11910 GREEN VALLEY RD
UNION BRIDGE MD
21791-8514
US

IV. Provider business mailing address

11910 GREEN VALLEY RD
UNION BRIDGE MD
21791-8514
US

V. Phone/Fax

Practice location:
  • Phone: 443-789-7098
  • Fax:
Mailing address:
  • Phone: 443-789-7098
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR204713
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: