=====================================================
General NPI Number Information
=====================================================
NPI Number | 1245831403
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JULIA PATRICE WATKINS CPT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/04/2020
-----------------------------------------------------
Last Update Date | 11/04/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 254 W BAY AVE # F112
-----------------------------------------------------
City | NORFOLK
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23503-4564
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 757-355-3247
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 254 W BAY AVE # F112
-----------------------------------------------------
City | NORFOLK
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23503-4564
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 757-355-3247
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 172V00000X
-----------------------------------------------------
Taxonomy Name | Community Health Worker
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 202C00000X
-----------------------------------------------------
Taxonomy Name | Independent Medical Examiner Physician
-----------------------------------------------------
License Number | P2N2E2N3
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------