Healthcare Provider Details

I. General information

NPI: 1629115019
Provider Name (Legal Business Name): MS. REBECCA P WATKINS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: REBECCA P WATKINS R.N.

II. Dates (important events)

Enumeration Date: 02/01/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1006 E LAMAR ALEXANDER PKWY
MARYVILLE TN
37804-5132
US

IV. Provider business mailing address

440 DEFOE CIR
MARYVILLE TN
37804-2702
US

V. Phone/Fax

Practice location:
  • Phone: 865-983-4582
  • Fax: 865-983-4574
Mailing address:
  • Phone: 865-984-6847
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License NumberRN0000047263
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: