Healthcare Provider Details

I. General information

NPI: 1396956439
Provider Name (Legal Business Name): JUDY G WATKINS RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4700 MUELLER BRASS RD
COVINGTON TN
38019-3754
US

IV. Provider business mailing address

162 PHILLIPS ST
BRIGHTON TN
38011-4027
US

V. Phone/Fax

Practice location:
  • Phone: 901-476-0235
  • Fax:
Mailing address:
  • Phone: 901-476-1695
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License NumberRN0000029037
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: