Healthcare Provider Details

I. General information

NPI: 1255737169
Provider Name (Legal Business Name): NITA WATKINS CMA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/05/2014
Last Update Date: 11/05/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

315 LEMA PL
MEMPHIS TN
38105-3203
US

IV. Provider business mailing address

4506 MILL STREAM DR #3
MEMPHIS TN
38116-7434
US

V. Phone/Fax

Practice location:
  • Phone: 901-401-0344
  • Fax: 901-396-4668
Mailing address:
  • Phone: 901-396-4668
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246RP1900X
TaxonomyPhlebotomy Technician
License Number855244
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: