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General NPI Number Information
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NPI Number | 1174936462
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Entity Type | Individual
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Provider Name | TYLER EUGENE WATKINS FNP
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Gender | Male
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Dates
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Enumeration Date | 06/04/2014
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Last Update Date | 03/26/2025
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Provider Practice Location Address
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Address Line | 353 W IOWA AVE
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City | NAMPA
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State | ID
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Zip | 83686
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Country | US
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Telephone | 208-468-0485
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Fax |
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Provider Business Mailing Address
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Address Line | 3873 E RENWICK ST
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City | MERIDIAN
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State | ID
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Zip | 83642-6486
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Country | US
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Telephone | 480-430-3530
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | NP-1535A
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License Number State | ID
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | RN158139
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License Number State | AZ
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Taxonomy #3
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 2011013620
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License Number State | ID
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Taxonomy #4
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | NP-1535A
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License Number State | ID
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