Provider Demographics
NPI:1164184156
Name:WATKINS, TIFFANY NICOLE
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:NICOLE
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 1:1460 HUNT RD
Mailing Address - Street 2:
Mailing Address - City:CHLOE
Mailing Address - State:WV
Mailing Address - Zip Code:25235-7073
Mailing Address - Country:US
Mailing Address - Phone:304-918-3975
Mailing Address - Fax:
Practice Address - Street 1:1460 HUNT RD
Practice Address - Street 2:
Practice Address - City:CHLOE
Practice Address - State:WV
Practice Address - Zip Code:25235-7073
Practice Address - Country:US
Practice Address - Phone:304-918-3975
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-07
Last Update Date:2021-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant