Provider Demographics
NPI:1073961587
Name:WATKINS, GAYLE
Entity Type:Individual
Prefix:
First Name:GAYLE
Middle Name:
Last Name:WATKINS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4921 REGENCY CT
Mailing Address - Street 2:104
Mailing Address - City:WEST CHESTER
Mailing Address - State:OH
Mailing Address - Zip Code:45069-8803
Mailing Address - Country:US
Mailing Address - Phone:513-213-0826
Mailing Address - Fax:
Practice Address - Street 1:4921 REGENCY CT
Practice Address - Street 2:104
Practice Address - City:WEST CHESTER
Practice Address - State:OH
Practice Address - Zip Code:45069-8803
Practice Address - Country:US
Practice Address - Phone:513-213-0826
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-25
Last Update Date:2016-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN146921 M IV164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse