Healthcare Provider Details

I. General information

NPI: 1598773897
Provider Name (Legal Business Name): CHRISTOPHER J WATKINS NP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2006
Last Update Date: 08/10/2022
Certification Date: 08/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

557 GRANTS FERRY RD
BRANDON MS
39047-9023
US

IV. Provider business mailing address

557 GRANT FERRY RD
BRANDON MS
39047-7500
US

V. Phone/Fax

Practice location:
  • Phone: 601-665-4162
  • Fax: 855-830-3484
Mailing address:
  • Phone: 601-665-4162
  • Fax: 855-830-3484

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number857217
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: