Healthcare Provider Details

I. General information

NPI: 1336319482
Provider Name (Legal Business Name): ALISON L WATKINS M.M.S PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/05/2008
Last Update Date: 10/18/2023
Certification Date: 10/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6252 YELLOWSTONE RD
CHEYENNE WY
82009-3432
US

IV. Provider business mailing address

PO BOX 603725
CHARLOTTE NC
28260-3725
US

V. Phone/Fax

Practice location:
  • Phone: 307-778-2015
  • Fax: 307-778-7060
Mailing address:
  • Phone: 828-575-2625
  • Fax: 828-350-2174

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number435
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: