Healthcare Provider Details

I. General information

NPI: 1376979369
Provider Name (Legal Business Name): SHARMETRIS K WATKINS NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/23/2013
Last Update Date: 10/28/2020
Certification Date: 09/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15830 BALLANTYNE MEDICAL PL SUITE 275
CHARLOTTE NC
28277-4653
US

IV. Provider business mailing address

PO BOX 60447
CHARLOTTE NC
28260-0447
US

V. Phone/Fax

Practice location:
  • Phone: 704-542-0744
  • Fax: 704-543-7713
Mailing address:
  • Phone: 704-542-0744
  • Fax: 704-543-7713

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number5006426
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number5006426
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: