Provider Demographics
NPI:1295407435
Name:WATKINS, TYLER (CRNP)
Entity Type:Individual
Prefix:
First Name:TYLER
Middle Name:
Last Name:WATKINS
Suffix:
Gender:M
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4300 W MAIN ST STE 405
Mailing Address - Street 2:
Mailing Address - City:DOTHAN
Mailing Address - State:AL
Mailing Address - Zip Code:36305-1086
Mailing Address - Country:US
Mailing Address - Phone:334-944-7073
Mailing Address - Fax:
Practice Address - Street 1:4300 W MAIN ST STE 405
Practice Address - Street 2:
Practice Address - City:DOTHAN
Practice Address - State:AL
Practice Address - Zip Code:36305-1086
Practice Address - Country:US
Practice Address - Phone:334-944-7073
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-05
Last Update Date:2022-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-174232363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty