Provider Demographics
NPI:1245563816
Name:WATKINS, GAIL LEANNE (PA-C)
Entity Type:Individual
Prefix:MS
First Name:GAIL
Middle Name:LEANNE
Last Name:WATKINS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MISS
Other - First Name:GAIL
Other - Middle Name:LEANNE
Other - Last Name:CROWE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10470 OLD PLACERVILLE RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95827-2539
Mailing Address - Country:US
Mailing Address - Phone:800-470-0071
Mailing Address - Fax:
Practice Address - Street 1:24685 STATE HWY 88
Practice Address - Street 2:
Practice Address - City:PIONEER
Practice Address - State:CA
Practice Address - Zip Code:95666
Practice Address - Country:US
Practice Address - Phone:209-257-7500
Practice Address - Fax:209-257-7501
Is Sole Proprietor?:No
Enumeration Date:2009-09-14
Last Update Date:2015-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA 20484363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACR105YMedicare PIN