MEDICARE: KATHY L WATKINS

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	367A00000X	Advanced Practice Midwife	CNM-46A	ID
2	367A00000X	Advanced Practice Midwife	13739230-4402	UT

General Provider Information

NPI Number	:	1659322261
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHY L WATKINS

Provider Business Mailing Address
First Line	:	PO BOX 27128
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84127-0128
Country	:	US
Telephone Number	:
Fax Number	:	208-236-7051

Provider Business Practice Location Address
First Line	:	201 W LAYTON PKWY STE 2B
Second Line	:
City	:	LAYTON
State	:	UT
Zip	:	84041-3692
Country	:	US
Telephone Number	:	801-543-6850
Fax Number	:

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

Provider Enumeration Date	:	05/16/2006
Last Update Date	:	03/25/2025

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