MEDICARE: MS. VALERIE WATKINS PHYSICIAN ASSISTANT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant

General Provider Information

NPI Number	:	1295859270
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. VALERIE WATKINS PHYSICIAN ASSISTANT

Provider Business Mailing Address
First Line	:	1 US ARMY
Second Line	:
City	:	MANHATTAN
State	:	KS
Zip	:	66503-8616
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2991 GARDEN AVE
Second Line	:
City	:	FORT SAM HOUSTON
State	:	TX
Zip	:	78234-7598
Country	:	US
Telephone Number	:	210-326-9222
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/16/2007
Last Update Date	:	03/06/2012

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