Provider Demographics
NPI:1275420200
Name:WATKINS, MARY VICTORIA (APRN, PMHNP)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:VICTORIA
Last Name:WATKINS
Suffix:
Gender:F
Credentials:APRN, PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4637 LEMONWOOD LN
Mailing Address - Street 2:
Mailing Address - City:ODESSA
Mailing Address - State:TX
Mailing Address - Zip Code:79761-3523
Mailing Address - Country:US
Mailing Address - Phone:843-742-9335
Mailing Address - Fax:
Practice Address - Street 1:4637 LEMONWOOD LN
Practice Address - Street 2:
Practice Address - City:ODESSA
Practice Address - State:TX
Practice Address - Zip Code:79761-3523
Practice Address - Country:US
Practice Address - Phone:843-742-9335
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-23
Last Update Date:2025-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC30543163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health