Healthcare Provider Details

I. General information

NPI: 1508166109
Provider Name (Legal Business Name): ROCHELLE KATHRYN WATKINS CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ROCHELLE KATHRYN JERNEE CNP

II. Dates (important events)

Enumeration Date: 10/28/2010
Last Update Date: 10/28/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1483 W MAIN ST
TIPP CITY OH
45371-2803
US

IV. Provider business mailing address

1483 W MAIN ST
TIPP CITY OH
45371-2803
US

V. Phone/Fax

Practice location:
  • Phone: 937-667-7713
  • Fax: 937-667-8067
Mailing address:
  • Phone: 937-667-7713
  • Fax: 937-667-8067

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberNP-07918
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: