Provider Demographics
NPI:1104395375
Name:WATKINS, WILLIAM RAY JR (RN, MSN, NP)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:RAY
Last Name:WATKINS
Suffix:JR
Gender:M
Credentials:RN, MSN, NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:214 HANGING ROCK HWY
Mailing Address - Street 2:
Mailing Address - City:LOGAN
Mailing Address - State:WV
Mailing Address - Zip Code:25601-5102
Mailing Address - Country:US
Mailing Address - Phone:304-784-4995
Mailing Address - Fax:
Practice Address - Street 1:214 HANGING ROCK HWY
Practice Address - Street 2:
Practice Address - City:LOGAN
Practice Address - State:WV
Practice Address - Zip Code:25601-5102
Practice Address - Country:US
Practice Address - Phone:304-784-5404
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-17
Last Update Date:2018-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV80052363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily