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General NPI Number Information
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NPI Number | 1184126732
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Entity Type | Individual
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Provider Name | SHEILA RAE WATKINS PA-C
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Gender | Female
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Dates
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Enumeration Date | 02/28/2018
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Last Update Date | 12/19/2019
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Provider Practice Location Address
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Address Line | 10430 LOVELL CENTER DR
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City | KNOXVILLE
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State | TN
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Zip | 37922-3227
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Country | US
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Telephone | 865-693-6620
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Fax |
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Provider Business Mailing Address
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Address Line | 529 ANNANDALE RD
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City | KNOXVILLE
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State | TN
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Zip | 37934-5042
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Country | US
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Telephone | 309-202-3004
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 085-006837
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 1033220314
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License Number State | TN
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