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NPI Code Detail

MEDICARE: DAVID JACK WATKINS FNP-BC

MEDICARE:   DAVID JACK WATKINS  FNP-BC
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
1363LF0000XFamily Nurse PractitionerAP61518780WA
2363LF0000XFamily Nurse Practitioner293477-4405UT

General Provider Information

NPI Number : 1649283979
Entity Type Code : Individual
Provider Name (Legal Business Name) : DAVID JACK WATKINS FNP-BC
Provider Business Mailing Address
First Line : 1055 N 500 W
Second Line :
City : PROVO
State : UT
Zip : 84604-3305
Country : US
Telephone Number : 435-528-2130
Fax Number : 435-528-2186
Provider Business Practice Location Address
First Line : 12 S 8TH ST
Second Line :
City : YAKIMA
State : WA
Zip : 98901-3020
Country : US
Telephone Number : 509-454-4143
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/15/2006
Last Update Date : 12/23/2025

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Directions to “ DAVID JACK WATKINS FNP-BC” Practice Location

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