Healthcare Provider Details

I. General information

NPI: 1013956721
Provider Name (Legal Business Name): DAVID SCOTT WATKINS PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2006
Last Update Date: 03/23/2026
Certification Date: 03/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12 KANAWHA TER
SAINT ALBANS WV
25177-2750
US

IV. Provider business mailing address

1 KENTON DR STE 100
CHARLESTON WV
25311-1256
US

V. Phone/Fax

Practice location:
  • Phone: 304-757-6999
  • Fax:
Mailing address:
  • Phone: 304-306-8990
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number901
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: