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General NPI Number Information
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NPI Number | 1093578114
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Entity Type | Individual
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Provider Name | MELISSA ANN WATKINS FNP-C
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Gender | Female
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Dates
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Enumeration Date | 02/01/2024
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Last Update Date | 02/01/2024
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Provider Practice Location Address
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Address Line | 108 W 15TH ST
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City | CARUTHERSVILLE
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State | MO
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Zip | 63830-2202
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Country | US
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Telephone | 573-333-0033
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Fax |
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Provider Business Mailing Address
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Address Line | 3814 GREENWELL RD
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City | CARUTHERSVILLE
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State | MO
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Zip | 63830-8169
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Country | US
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Telephone | 573-724-6692
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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 | 363LP2300X
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Taxonomy Name | Primary Care Nurse Practitioner
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License Number | 2024003909
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License Number State | MO
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