Healthcare Provider Details

I. General information

NPI: 1881382836
Provider Name (Legal Business Name): DEVEN ALI WATKINS FNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/27/2023
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1111 HUFFMAN MILL RD
BURLINGTON NC
27215-8862
US

IV. Provider business mailing address

PO BOX 5105
BELFAST ME
04915-5100
US

V. Phone/Fax

Practice location:
  • Phone: 336-584-5544
  • Fax: 336-584-4438
Mailing address:
  • Phone: 919-220-5255
  • Fax: 336-584-4438

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number303991
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF03230328
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: