1336319482 NPI number — MRS. ALISON L WATKINS M.M.S PA-C

Table of content: MRS. ALISON L WATKINS M.M.S PA-C (NPI 1336319482)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336319482 NPI number — MRS. ALISON L WATKINS M.M.S PA-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WATKINS
Provider First Name:
ALISON
Provider Middle Name:
L
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
M.M.S PA-C
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1336319482
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/18/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 603725
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHARLOTTE
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28260-3725
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
828-575-2625
Provider Business Mailing Address Fax Number:
828-350-2174

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6252 YELLOWSTONE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHEYENNE
Provider Business Practice Location Address State Name:
WY
Provider Business Practice Location Address Postal Code:
82009-3432
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
307-778-2015
Provider Business Practice Location Address Fax Number:
307-778-7060
Provider Enumeration Date:
03/05/2008

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363A00000X , with the licence number:  435 , registered in the state of WY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 10027099700 , issued by the state of ( NE ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1688 . This is a "LICENSE" identifier , issued by the state of ( CO ) . This identifiers is of the category "OTHER".
  • Identifier: 435 . This is a "WY LIC 435" identifier , issued by the state of ( WY ) . This identifiers is of the category "OTHER".
  • Identifier: W33945 . This is a "MEDICARE" identifier , issued by the state of ( WY ) . This identifiers is of the category "OTHER".
  • Identifier: 10027099703 , issued by the state of ( NE ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2D4405 . This is a "MEDICARE" identifier , issued by the state of ( CO ) . This identifiers is of the category "OTHER".
  • Identifier: 10027099702 , issued by the state of ( NE ) . This identifiers is of the category "MEDICAID".
  • Identifier: 142755500 , issued by the state of ( WY ) . This identifiers is of the category "MEDICAID".




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