Healthcare Provider Details

I. General information

NPI: 1205483161
Provider Name (Legal Business Name): JULIA TERESA WATKINS RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/23/2019
Last Update Date: 08/23/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1213 ETTRICK AVE
ROCK HILL SC
29732-2987
US

IV. Provider business mailing address

1213 ETTRICK AVE
ROCK HILL SC
29732-2987
US

V. Phone/Fax

Practice location:
  • Phone: 803-487-6830
  • Fax:
Mailing address:
  • Phone: 803-487-6830
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number203375
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: