Healthcare Provider Details

I. General information

NPI: 1912693169
Provider Name (Legal Business Name): DANA RAE WATKINS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/12/2023
Last Update Date: 08/03/2026
Certification Date: 08/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 HOLLY SPRINGS RD STE 106
HOLLY SPRINGS NC
27540-6204
US

IV. Provider business mailing address

500 HOLLY SPRINGS RD STE 106
HOLLY SPRINGS NC
27540-6204
US

V. Phone/Fax

Practice location:
  • Phone: 910-699-4470
  • Fax: 919-238-1146
Mailing address:
  • Phone: 910-699-4470
  • Fax: 919-238-1146

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0010-16068
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: