Provider Demographics
NPI:1225381759
Name:WATKINS, INGRID KERNIZAN (FNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:INGRID
Middle Name:KERNIZAN
Last Name:WATKINS
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7151 S TALMAN AVE APT 1
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60629-2013
Mailing Address - Country:US
Mailing Address - Phone:773-978-5291
Mailing Address - Fax:
Practice Address - Street 1:2112 W PETERSON AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60659-4277
Practice Address - Country:US
Practice Address - Phone:773-921-9669
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-22
Last Update Date:2016-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209009559363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily