Healthcare Provider Details

I. General information

NPI: 1225890684
Provider Name (Legal Business Name): BRIANNA NICOLE WATKINS PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/30/2024
Last Update Date: 02/06/2024
Certification Date: 02/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1040 RIVER OAKS DR STE 103
FLOWOOD MS
39232-9531
US

IV. Provider business mailing address

1040 RIVER OAKS DR STE 103
FLOWOOD MS
39232-9531
US

V. Phone/Fax

Practice location:
  • Phone: 601-948-6540
  • Fax:
Mailing address:
  • Phone: 601-948-6540
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: