Healthcare Provider Details

I. General information

NPI: 1073432415
Provider Name (Legal Business Name): DORNESHA WATKINS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/10/2026
Last Update Date: 07/10/2026
Certification Date: 06/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14111 WILLIE MELTON BLVD
KENDLETON TX
77451
US

IV. Provider business mailing address

PO BOX 772
KENDLETON TX
77451-0772
US

V. Phone/Fax

Practice location:
  • Phone: 346-901-9039
  • Fax:
Mailing address:
  • Phone: 346-901-9039
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: