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General NPI Number Information
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NPI Number | 1013491968
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Entity Type | Individual
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Provider Name | SHANNON WATKINS PA-C
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Gender | Female
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Dates
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Enumeration Date | 09/17/2018
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Last Update Date | 08/22/2023
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Provider Practice Location Address
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Address Line | 370 E VIRGINIA AVE STE 100
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City | PHOENIX
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State | AZ
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Zip | 85004-1254
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Country | US
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Telephone | 602-258-4788
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Fax |
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Provider Business Mailing Address
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Address Line | 20808 N 27TH AVE APT 2030
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City | PHOENIX
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State | AZ
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Zip | 85027-3235
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | 7230
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License Number State | AZ
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