Healthcare Provider Details

I. General information

NPI: 1194076521
Provider Name (Legal Business Name): WILLIAM TEAL WATKINS N.P.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/25/2012
Last Update Date: 08/17/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

593 EDDY ST ORTHOPAEDIC DEPT. COOP BUILDING
PROVIDENCE RI
02903-4923
US

IV. Provider business mailing address

593 EDDY ST ORTHOPAEDIC DEPT. COOP BUILDING
PROVIDENCE RI
02903-4923
US

V. Phone/Fax

Practice location:
  • Phone: 401-444-5662
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberNPP37837
License Number StateRI
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPRN00346
License Number StateRI
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number21866
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: