Healthcare Provider Details

I. General information

NPI: 1316701394
Provider Name (Legal Business Name): HEATHER ELAINE WATKINS AGPCNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/09/2024
Last Update Date: 12/03/2024
Certification Date: 12/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

106 JEFFERSON ST
HAMLET NC
28345-3100
US

IV. Provider business mailing address

PO BOX 187
FAISON NC
28341-0187
US

V. Phone/Fax

Practice location:
  • Phone: 910-557-9447
  • Fax: 888-226-0864
Mailing address:
  • Phone: 910-267-2042
  • Fax: 855-996-9090

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number5019583
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: