Provider Demographics
NPI:1295386324
Name:WATKINS, AMANDA LEA
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:LEA
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 1:930 MLK BLVD STE 202
Mailing Address - Street 2:
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27514-2656
Mailing Address - Country:US
Mailing Address - Phone:919-933-3301
Mailing Address - Fax:919-933-3375
Practice Address - Street 1:930 MLK BLVD STE 202
Practice Address - Street 2:
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27514-2656
Practice Address - Country:US
Practice Address - Phone:919-933-3301
Practice Address - Fax:919-933-3375
Is Sole Proprietor?:No
Enumeration Date:2019-09-20
Last Update Date:2019-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCL004546133V00000X
NCL-36179174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN
No133V00000XDietary & Nutritional Service ProvidersDietitian, Registered