Healthcare Provider Details

I. General information

NPI: 1649283979
Provider Name (Legal Business Name): DAVID JACK WATKINS FNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/15/2006
Last Update Date: 11/06/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

131 E MAIN ST STE. 3
SALINA UT
84654-1335
US

IV. Provider business mailing address

1055 N 500 W
PROVO UT
84604-3305
US

V. Phone/Fax

Practice location:
  • Phone: 435-528-2130
  • Fax: 435-528-2186
Mailing address:
  • Phone: 435-528-2130
  • Fax: 435-528-2186

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number293477-4405
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: